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Full text of "Medicine in China"

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THE LIBRARY 

OF 

THE UNIVERSITY 

OF CALIFORNIA 

LOS ANGELES 




i 

* .1 



Medicine in China 

by the ' 

China Medical Commission of the 
Rockefeller Foundation 



New York 
1914 



t\ — 



Medicine in China 

by the 

China Medical Commission of the 
Rockefeller Foundation 



New York 
1914 



Composed and Printed By 

The University of Chicagfo Press 

Chicago, Illinois, U.S.A. 



WB 

50 
JCfe 

CONTENTS 

PAGE 

Introduction v 

I. Health Conditions in China 1 

II. Chinese Native Medicine and Surgery ... 6 

III. Western Medicine in China 8 

1. Practitioners of Western Methods .... 8 

2. Chinese Government and Private Medical Schools 9 

3. Missionary Medical Schools 17 

4. Education of Women Physicians 34 

5. Non-missionary Medical Schools under Foreign 
Control 38 

6. Locations Considered for Medical Education . . 41 

7. Hospitals in China 53 

IV. Standards of Medical Education under Mission- 
ary Auspices. Teaching in Chinese or in English 81 

V. Dissection and Autopsies 86 

i/ VI. The Ati:itude of the Chinese toward Modern 

Medicine 90 

VII. Recommendations of the Commission .... 91 

Appendixes 99 

Map of China 



782341 



INTRODUCTION 

The Rockefeller Foundation at a meeting held in New York, 
January 29, 1914, voted to establish a Commission to study and 
report on conditions of public health and medicine in China. In 
accordance with this vote the Foundation further appointed the 
following persons to constitute the Commission: 

Harry Pratt Judson, LL.D., President of the University of 
Chicago, Trustee of the Rockefeller Foundation, Member 
of the General Education Board, etc., Chairman 

Roger Sherman Greene, A.M., Consul-General of the United 
States of America at Hankow 

Francis Weld Peabody, M.D., of Harvard University and 
the Peter Bent Brigham Hospital, Boston. 



George Baldwin McKibbin, J.D., Secretary to the Commis- 
sion. 

The Commission was provided with formal credentials on behalf 
of the Foundation. The Secretary of State of the United States, 
the Honorable William J. Bryan, kindly provided letters of intro- 
duction to the American Minister in China, the Honorable Paul S. 
Reinsch, to the American Ambassador in Japan, the Honorable 
George W. Guthrie, and also to all American consular representa- 
tives in China and Japan. The Secretary of State further very 
generously gave leave of absence to Consul-General Greene in order 
that he might perform the duties of a member of the Commission. 

The Chairman and the Secretary left Chicago March 18 for 
Washington, D.C. While in Washington the Chairman was the 
guest of the Honorable John W. Foster, former Secretary of State 
of the United States, and legal representative for many years of 
the Chinese legation in Washington. While in that city a call was 
made on the President of the United States, who expressed cordial 
interest in the purpose of the Commission; and on the Chinese 



vi Introduction 

Charge, Mr. Yung Kwar, who provided letters of introduction to Chi- 
nese officials in Peking. The Chairman also met Mr. E. T. WiUiams, 
head of the Far Eastern Division in the Department of State, the 
Secretary of State of the United States and a number of other 
people who were interested in the Far East. 

The Chairman, Dr. Peabody, and the Secretary and the two 
ladies of the party sailed from New York on the Hamburg-American 
Stpamer "Imperator," Saturday, March 21, 1914, From Cherbourg 
the party proceeded to Moscow, stopping a few days in several cities 
enroute. Leaving Moscow April 8, they arrived at Peking April 18. 
On the following day, April 19, the party was joined by Mr. Greene 
coming from Hankow. 

The first formal meeting of the Commission was held on April 20, 
at which time the general plans for work were outlined. Until 
May 11 the Commission remained in Peking, studying the situation 
there, and in Tientsin, examining the various medical schools and 
hospitals in that city, making the acquaintance of important officials 
of the government, and organizing plans for the subsequent work 
in other parts of China. The Commission was received by the 
President of the Republic, Yuan Shih K'ai, was entertained at 
diimer by the Vice-President, Li Yuan Hung, and was able to meet 
other important officials. Blanks were prepared and sent to hos- 
pitals and medical schools to be returned to the Commission in order 
to secure from the workers on the field a statement of the facts within 
their knowledge. Meanwhile, Mr. E. C. Sage, one of the Secretaries 
of the General Education Board, had provided the Commission 
before it left New York with a large mass of reports as to medical 
work in China from various missionary bodies in the United States. 
Later Mr. Sage proceeded to England and obtained similar material 
from the various mission bodies in that country. 

It was decided that the Commission would be more effective 
by dividing for a part of its work. Accordingly on the 11th of May 
Dr. Peabody and Mr. Greene proceeded to Hankow by train, plan- 
ning to stop enroute at various places for the inspection of hospitals. 
Meanwhile the Chairman and Secretary examined several institutions 
in Shantung province, going first into the interior by rail, and then 
taking steamer from Tientsin for Shanghai, stopping enroute at 



Introduction vii 

Chefoo and Tsingtau. After examining the work in Shanghai, 
Nanking, and vicinity the party went by river to Hankow, stop- 
ping enroute at Kiukiang. Meanwhile Mr. Greene and Dr. Pea- 
body had reached Hankow and spent some time in visiting schools 
and hospitals in that vicinity and at Changsha. The Commission 
met at Hankow for a general discussion and the arrangement of 
subsequent plans. The Chairman visited Changsha, and then pro- 
ceeded to Peking for a conference with the Minister of Education, 
then by rail again to Shanghai where he was joined by Dr. Peabody 
and Mr. Greene, who had come down the river, stopping at a num- 
ber of places which the Chairman had not seen. The entire party 
then proceeded by sea to Hongkong. Brief visits were made at 
Canton and then ship was taken for Manila. Here the general 
hospital and University Medical School were visited and the 
health work under the charge of Dr. Heiser. The Chairman and 
Secretary, accompanied by the ladies, returned to Hongkong and 
made another visit to Canton besides examining the work at Hong- 
kong. On July 23 they sailed for Japan, stopping enroute at 
Keelung, on the Island of Formosa, and at Shanghai. Dr. Peabody 
and Mr. Greene remained in Manila, sailing from there July 21 
for Hongkong. From that place they proceeded by coasting 
vessels for a visit to the institutions at Swatow, Amoy, and 
Foochow, reaching Shanghai August 2. They remained in Shanghai 
and vicinity until August 14, when they sailed for Japan, the 
party being reunited at Kyoto August 17. Here further meetings 
of the Commission were held, the material gathered was studied 
and the report drafted. 

Altogether the members of the Commission visited seventeen 
medical schools and ninety-seven hospitals in China and Manila. Of 
the nine mission medical schools in the list of the Medical Mission- 
ary Association, seven were visited, the only ones omitted being 
Moukden in Manchuria and Chengtu in Szechuan. Visits were 
also made to various universities and secondary schools, both mis- 
sionary and governmental. Conferences were held with a great 
number of medical missionaries and officials of the Y.M.C.A. in 
China, with leading officials of the central government and of the 
governments of the various provinces and with many other persons 



viii Introduction 

in positions of influence, both European and Chinese. Of the 
eighteen provinces of China proper, the Commission visited eleven. 

It should be said that everywhere members of the Commission 
were received with great courtesy and with great helpfulness. 

The Minister of the United States to China, Hon. Paul S. Reinsch, 
and the American Consuls in the various parts of China were very 
kind and helpful. Chinese officials everywhere assisted the work, 
giving all information in their power and extending every privilege 
which could be desired. 

It is believed that the schools and hospitals seen comprise the 
most important and on the whole those which are typical. It is 
doubted whether if visits had been made to all the other missionary 
hospitals in China any important additional information could have 
been obtained. The reports furnished by the missionary bodies 
through Mr. Sage and those obtained from the missionary bodies 
on the field embody a great mass of information which is very useful 
to the Commission and will be of importance hereafter for the use 
of the Foundation. 

The conclusions which the Commission has reached are based 
on what it believes to be a careful study and the facts submitted 
afford a means for the verification of the report. 



HEALTH CONDITIONS IN CHINA 

It must be understood at the outset that in China statistics of any 
sort hardly exist. Such statistics on financial matters as belong to 
the Customs service are of value within their field. Incidentally the 
Customs service has gathered within some treaty ports certain facts 
with regard to health in those places. Naturally these are very 
limited in their character and relate to ports which have more or 
less European influence and in which health conditions on the whole 
are presumably better than they are in other places within the 
Republic. One can only judge as to general conditions by what is 
observed in different parts of the Republic and by the observations 
and opinions of those in touch with medical affairs as they exist. 
From these various sources one can conclude only that diseases are 
rife throughout the Republic and that the death rate is probably 
higher than in any other known country. If these inferences are 
correct it must follow that the economic results of prevailing lesions 
of public health are themselves most serious. In other words, the 
mental power and economic efl&ciency of the nation as a whole must 
be enormously lessened. 

It has been said by some Chinese that taking things as they are 
in China today, a high death rate is not on the whole undesirable; 
that there are too many people in the country, that the popu- 
lation is increasing too rapidly, that the pressure on the means 
of subsistence is excessive, and that a diminution of population 
caused by wide-spread disease, whether pestilence or otherwise, is on 
the whole a benefit. Aside from any question of the humanitarian 
bearing of such an attitude, it must be noted that there is here 
ignored the enormous importance of the economic effects of wide- 
spread disease. If a nation is healthy and energetic and efficient, 
it will be able greatly to increase its productive power from an 
economic point of view. There can be no doubt also that while 
in certain parts of the Republic the population is congested, never- 
theless there are large areas in which arable land is untilled and that 

1 



2 China Medical Commission 

there are also large sources of national wealth which are practically 
untouched. Mines of various metals are known to exist in large 
quantities and there can be little doubt that further investigation 
will disclose further great deposits of coal, iron, copper, and other 
valuable products which can be mined with success. The develop- 
ment of the system of railroads which is already under way must 
proceed jpari passu with the opening of mines, and the two together 
will offer a large outlet for labor. The great hill surfaces of China 
which have long since been denuded of their forest supply must be 
re-forested. This again will employ a considerable body of labor 
and the incidental work connected with the process will reclaim con- 
siderable areas of cultivable land. The restriction of the numerous 
rivers of China from devastating annual overflows, a matter which 
seems to be quite within the limits of engineering capacity, will also 
provide another outlet for labor and at the same time will reclaim 
further areas of valuable agricultural lands. In other words, it seems 
quite possible for the population of China to be supported in comfort 
not only at its present rate of increase, but at a much larger rate. 
So far as the abnormal increase of population in China, coming from 
beliefs and practices more or less connected with religion, is con- 
cerned, it seems reasonable to suppose that time and the develop- 
ment of the country along western lines will suflSciently provide for 
that. The whole tendency of an increase in national well-being in 
western lands has been unfailing in the direction of lessening rather 
than increasing the birth-rate. That tendency may be somewhat 
checked by special conditions in China, but in the long run economic 
forces cannot be stopped in their operation and China must find 
true within itself what the rest of the world has been compelled to 
heed universally. 

The Commission has been informed from many sources that the 
most destructive and wide-spread diseases of China at present are 
tuberculosis, hookworm, and syphilis. These are everywhere obvious 
and their results are believed to be increasingly conspicuous. Leprosy 
also prevails and only in sporadic cases apparently has there been 
any attempt at its obliteration. Of course, to stamp out such dis- 
eases systematic governmental action is necessary. As to tubercu- 
losis, provision for sanatoria is entirely possible so far as proper 



Health Conditions in China 3 

locations are concerned, but little has thus far been attempted in 
that direction. 

The sudden introduction of foreign conditions has had a natural 
result on the status of health. Railways, modern engineering, 
machinery, and other forms of industrial activity have brought with 
them the usual accompaniments of accidents and of occupational 
diseases. The crowding necessitated by the opening of schools and 
factories has also brought in new forms of physical trouble. The 
increased amount of travel made possible by railways and steamboats 
has resulted in more effective distribution of infectious disease over 
large territories. Cholera and bubonic plague have at times been 
especially threatening in the south, while the famines resulting from 
the inundation of great areas by Chinese rivers have their uniform 
sequents in wide-spread typhus. 

It is only fair to point out that the evil results to health which 
might be expected from the unhygienic conditions of Chinese life 
are prevented in part by certain wholesome habits of the Chinese 
people. Uncooked food is rarely eaten, and the customary drink 
is a weak infusion of tea made with boiling water. Boiled rice is the 
common food in the south, millet or wheat in the north, and meat 
is taken sparingly. 

The Chinese government, whether central or provincial, has not 
been able thus far to take comprehensive measures for public 
health. Small-pox is considered by the people as a matter of course, 
and an attempt to remove a patient from his home would be resented 
as an infringement on the liberty of the family. The various activi- 
ties of a public health service as practiced in western lands are 
almost unknown. Leprosy and tuberculosis rage unchecked. Isola- 
tion hospitals for contagious diseases hardly exist, so far as the 
government is concerned. The stegomyia mosquito swarms in the 
Yangtze valley and in the Canton delta, and western medical men 
are apprehensive that yellow fever may come in from South 
America. If it should, its ravages would be fearful. 

On the other hand there is some encouragement. 

The ravages of the pneumonic plague in Manchuria in the years 
1910-11 were so great as to excite general alarm, not only in China, 
but in other countries likely to suffer. The Chinese government 



4 China Medical Commission 

invited other nations to send delegates to an International Con- 
ference on the subject of plague prevention, and the conference 
was held at Moukden in 1911. The recommendations adopted by 
this conference were in part adopted by the Chinese government. 
A Plague Prevention Service has been established, under the direction 
of Dr. Wu Lien-teh, who presided over the deliberations of the 
Conference. Several plague hospitals have been established, which 
may be used for ordinary hospital purposes when no plague exists. 
The medical officers have power to advise local authorities as to 
sanitation in the district, and in the event of a plague epidemic will 
have full charge of all preventive and destructive measures. During 
the epidemic the government permitted autopsies, and thus the 
way was paved for the regulation of November 22, 1913, by which 
autopsies and dissection were officially authorized throughout the 
republic. 

The last two recommendations of the conference were as follows : 

44. "With a view to giving effect to these recommendations 
every endeavour should be made to organize a Central Public 
Health Department, more especially with regard to the manage- 
ment and notification of future outbreaks of infectious diseases." 

45. ''In furtherance of the above purposes every effort should be 
made to secure effective medical education in China." (Report of 
the International Plague Conference, 1911, p. 397.) 

Progress has not been made with reference to the establishment 
of a Central Public Health Department, but in several localities 
public officials have shown an intelligent interest in the subject. 

In Canton the republican government immediately after the 
revolution organized public-health work quite effectively. Streets 
were cleaned, cases of infectious diseases were isolated, a leper 
asylum was established on islands of the delta where lepers were 
systematically segregated, and other similar measures were adopted. 

In Changsha the Commission found a Police Commissioner 
who was also pursuing an enlightened policy as to public health, 
under the advice of the resident western educated physicians. 

In Nanking, not long since, a proclamation was issued by the 
Government and posted throughout the city saying that all night 
soil carriers must have covers on the buckets; that there must be no 



Health Conditions in China 5 

defecating on the streets; that public closets must be emptied every 
day; that butchers selling chopped meats must provide screens 
to protect the meats from flies; and that if any questions regarding 
public health should arise in the minds of the people, the Governor 
would be very glad to hear them. 

On the whole the time is ripe for a general advance in China in 
all matters relating to public health. 



II 

CHINESE NATIVE MEDICINE AND SURGERY 

It will of course not be expected that a nation so ancient in 
civilization as the Chinese should not have had a medical profession 
for many centuries. We find accordingly that time out of mind 
there have been practitioners of the healing art. There is a very 
elaborate Chinese materia medica. There are Chinese books in 
considerable number, many of them quite ancient in character, 
which deal with medical practice. One work on the pharmacopoea, 
the Pentsao, contains several copious volumes. The subject-matter 
has been treated in more concise form in a volume entitled "Chinese 
Materia Medica" by G. A. Stuart, M.D., Shanghai, 1911. The 
|j Proceedings of the Chinese Section of the Royal Asiatic Society for 
^1 1864 contain also an interesting article on Chinese medicine. 

The old-fashioned Chinese practitioner is subject to no legal 
requirements. Anyone who wishes may announce himself a physi- 
cian and practice as he pleases. In many cases such practice seems 
to be hereditary in certain families and many of the remedies are 
practically recipes handed down in the family through its traditions. 
The practitioner has the benefit presumably of some such inherited 
knowledge and he has also the books which custom has approved. 
Thus he has a great variety of recipes for given diseases. The 
Chinese native drug-stores provide the remedies in abundant quanti- 
ties. There can be no doubt that in some cases the herbs thus used 
have certain beneficial medicinal effects. The methods of diag- 
nosis and treatment are also peculiar. The diagnosis in the main 
is based on the pulse. Both pulses are taken and the Chinese 
treatises indicate no less than ninety-eight different types of 
pulse. 

A common method of treatment is that of puncturing the body 
with a needle. A chart of the human body on record contains no 
less than seven hundred spots which are indicated as the places in 
which it is safe to insert a needle without injuring a vital organ, 

6 



Chinese Native Medicine and Surgery 7 

The old practice makes use of some modern drugs; e.g., quinine 
is well known and commonly used. Inoculation for small-pox has 
long been practiced and vaccination is now fairly common. Modern 
patent medicines have obtained a large sale in China, and the 
more flamboyant their advertising, the more eagerly they are 
purchased. 

It may be added that the old Chinese practitioners claim to know 
about medicines and their effect upon the body but admit that they 
know practically nothing about surgery. The dissection of the ^ 
human body is contrary to the ideas of the Chinese relating to the v/ 
future life and is regarded with peculiar horror. The old Chinese 
ideas of anatomy therefore are peculiar. One chart on record for 
instance shows the oesophagus as passing through the heart and 
from there to the liver and from there to the stomach. 



Ill 

WESTERN MEDICINE IN CHINA 

III. 1 
PRACTITIONERS OF WESTERN METHODS 

Some physicians trained in western medicine are found practicing 
in China. Nearly all of these are gathered in the various treaty 
ports. A few are Europeans or Americans, but very few; more 
are Japanese. Some of these latter are scattered throughout the 
interior. How many there are it is impossible to say. So far as our 
observation goes they are not numerous and they are trained mostly 
in the lower grades of Japanese schools. There are a few Chinese 
who have been trained in western medicine. Opinions differ as to 
the number. Estimates made from quite independent sources, 
European and Chinese, substantially agree in saying that there are 
not more than forty-five to fifty-five who have been educated in 
Europe or the United States. Some of these are engaged in prac- 
tice but most are found only in the hospitals or medical schools. 
There are of course some Chinese who have been trained in mis- 
sionary medical schools in China and who are practicing. These 
cannot be many in number as it is known that the most of the gradu- 
ates of these schools are on the staffs of the various mission hospi- 
tals. The Commission found a few Chinese practitioners who were 
educated in Japan. None of these, so far as the Commission's 
observations went, was educated in any one of the Imperial Uni- 
versities. 

Outside the mission hospitals and outside the treaty ports there 
are very few practitioners in China who have had any training at all 
in western medicine and almost none who have been adequately 
trained. 



Western Medicine in China 9 

III. 2 

CHINESE GOVERNMENT AND PRIVATE MEDICAL SCHOOLS 

Government Schools 

LOCATION 

The central government maintains two medical schools, one at 
Peking, known as the Peking Medical Special College (Peiching I 
Hsueh Chuan Men Hsueh Hsiao), and one at Tientsin, the Pei- 
yang Military Medical College. 

A few provincial medical schools were started prior to the revo- 
lution, notably at Tientsin, Canton, Nanchang, and Wuchang, but 
none of these was very firmly established except that at Tientsin, 
and most of them have been closed on account of the lack of sufficient 
funds for their maintenance. 

In 1913 the provincial government of Kiangsu established at 
Soochow a school known as the Kiangsu Provincial Medical Special 
College. We have been told that there is a similar institution in 
Chekiang Province. So far as we can learn these two and the Peiyang 
Medical School at Tientsin, a civil institution supported by Chihli 
Province, are the only provincial schools now remaining, though a 
semi-private school at Nanchang, called the "Public Medical Special 
College," receives a subsidy from the Kiangsi provincial government. 
There is at Wuchang, in Hupei, the beginning of a private medical 
school called the "Wuchang Medical Special College." At Canton 
besides the Kung Yee Medical School, promoted by Dr. P. J. Todd, 
which is nominally maintained by a private Chinese association, 
there is another Chinese private institution known as the Kwong 
Hwa Medical School. It is said that other private medical schools 
are conducted in Canton by Chinese practitioners but we did not 
have time to look into them. All these schools, except the Peiyang 
Medical School, give their teaching in Chinese. 

With the exception of the Peiyang ]Medical School at Tientsin 
and the Kwong Hwa School at Canton, the Chinese government and 
private medical schools in China are almost exclusively under Japa- 
nese influence, practically all their staff having been trained in 
Japan or by Japanese teachers in China. Unfortunately most of 
the Chinese who have studied medicine in Japan have attended 



10 China Medical Commission 

second-grade schools, on account of the difficult entrance require- 
ments of the University medical schools. These men in recent years 
have been displacing the Japanese professors originally engaged by 
the government. 

Japanese Second-Grade Medical Schools 

These institutions, while they undoubtedly do some good work, 
are regarded by the Japanese as distinctly second-rate schools. 
Middle School (Chu Gakko) graduates are admitted to them directly, 
whereas to enter the University medical schools a preparatory course 
of three years in a Higher School (Koto Gakko) is required. For 
Japanese students there is a competitive examination for admission 
to the medical special colleges, only about one hundred ten usually 
being taken at Kyoto, for example, out of some eight hundred appli- 
cants. For Chinese apphcants, however, this competitive exami- 
nation is dispensed with, and they are admitted provided their 
knowledge of Japanese is sufficient. At Kyoto we were told that 
few or none of the Chinese medical students were graduates of the 
Japanese middle schools, and their preparation was said to be very- 
inadequate. Furthermore, upon completion of their course, they are 
not required to pass the same examination as their Japanese class- 
mates, nor is the regular degree granted to them. They are given 
instead a certificate showing that they have done the work required. 
Japanese graduates are granted the degree of Bachelor of Medi- 
cine (I-Gakushi), the same as that given by the universities, 
with the exception that the graduates from "special colleges" are 
required to add the name of the institution from which they received 
their degree. 

The Medical Special College at Kyoto made in many respects a 
rather pleasant impression. It seemed fairly well equipped, and 
its hospital, which is primarily a therapeutic institution belong- 
ing to Kyoto prefecture, was well kept, but the number of beds 
available for teaching purposes is inadequate, being only fifty-two, 
while there are about one hundred ten students in each class of 
the four-year course. This school has a staff of twenty-one 
professors, seven assistant professors, two instructors, and nine 
lecturers. 



Western Medicine in China 11 

Regulations for Medical Special Colleges in China 

An order of the Department of Education of the RepubUcan 
government, issued November 22, 1912, outlines the work of the 
"Medical Special Colleges" and prescribes in detail the subjects 
which must be taught. A translation of the order is given in Appen- 
dix B 3. These colleges are intended to correspond to the institu- 
tions of the same name in Japan, and the curriculum is nominally 
almost the same, except that the Chinese college is obliged to provide 
instruction in physics and chemistry which in Japan is taken care of 
in the middle schools. The regular course is four years, but it is pro- 
vided that preparatory and graduate departments may be added. 
All public and private schools calling themselves "special colleges" 
are nominally required to conform to the government regulations 
and must submit their schedule of studies, showing the number of 
hours allotted to each, to the Department of Education for its 
approval. 

Peking Medical Special College 

Admission. — Candidates for admission to the Peking Medical 
Special College, as to all "special colleges," must be graduates of a 
middle school or have other equivalent preparation,^ must be males 
between the ages of sixteen and twenty-five, and must be in good 
physical condition. They are required to give surety for their good 
behavior. The college regulations provide that between sixty and 
one hundred students may be admitted annually. If the number of 
qualified students exceeds the number which the school can receive, 
competitive examinations are to be held in the following subjects: 
one foreign language (English or German), Chinese, algebra and 
geometry, physics, chemistry, and natural history, all these subjects 
being up to the standard of the middle schools. An examination 
fee of $2 . 00 Mex. or about ninety cents gold is charged which is not 
returned to either successful or unsuccessful candidates. 

On admission the student is required to pay in advance his 

tuition fees for the whole term which amount to S7 . 00 Mex. The 

tuition fees for the first year come to $20 . 00 Mex. or about $9 . 00 

gold. Students are required to pay for their own board and 

^ The subjects taught in the middle schools are enumerated in a government 
regulation of which a translation is given in Appendix B 4. 



12 China Medical Commission 

lodging. Those who do not live at home are required to reside in 
the college dormitories. Students are required to wear the college 
uniform. 

The academic year begins September 11 and ends on June 30. 
February 12, October 10 and 17, and November 16 are holidays. 
There is a winter vacation from December 26 to January 9, and a 
spring vacation from April 1 to 7. 

Curriculum. — The schedule of studies showing the hours assigned 
to each subject in each term of the four-year course at the Peking 
Medical Special College is given in Appendix B 5. It will be noted 
that a great deal of time is devoted to the study of German, ten 
hours a week during the first two terms of the first year, eight 
hours during the third term, six hours during two-thirds of the 
second year, and thereafter four hours a week until graduation. 
During the greater part of the first year non-medical studies 
(German, chemistry, physics, ethics, Chinese literature, and gym- 
nastics) take up twenty out of the thirty-six hours of formal 
work prescribed, leaving inadequate time for the strictly profes- 
sional studies. 

The school has now been in operation two years, and has, there- 
fore, only two classes, containing together about seventy students 
from different parts of the country. 

There are ten professors, a few of whom are Japanese, and some 
of the others are Chinese graduates of Japanese schools. The in- 
structor in German is a Chinese who studied at Tsingtau. 

At present the college is using some old Chinese buildings in 
which have been fitted up lecture rooms, a small chemical labora- 
tory, and two laboratories devoted to anatomy, in One of which 
there are two dissecting tables. We were informed that some dis- 
secting had already been done there, but it is evident that as yet not 
even the government schools have really taken advantage of the 
government legalization of dissecting to do this work on a systematic 
basis. There are also small laboratories for histological and bacte- 
riological work with fair equipment of apparatus. The school had 
last spring no hospital connection, but some arrangement for clinical 
facilities will be required during the coming year, and it was hoped 
that a hospital would be obtained soon. 



Western Medicine in China 13 

Military Medical College 

The Peiyang Military Medical College at Tientsin was estab- 
lished about ten years ago with a staff made up mainly of Japanese 
professors, but two years ago all the Japanese were replaced by 
Chinese. 

The institution has the same admission requirements as the 
Peking Medical Special College, it has the four-year course, and the 
standard of instruction is evidently about the same. A translation 
of the schedule of courses is given in Appendix B 6. One difference 
is that Japanese is taught during the first year and German only 
during the last three years. 

There are at present twenty-three professors, of whom fourteen 
give instruction in strictly medical subjects, while six are in the 
department of pharmacy, which is attached to the college, and three 
teach Japanese, German, and physics. Eight of the professors have 
studied in Japan and the remainder are mainly graduates of the 
college. There are about two hundred twenty students in the medi- 
cal college proper and about sixty in the school of pharmacy. The 
college possesses fairly spacious buildings, and quite a large quantity 
of apparatus of various kinds, but its laboratory facilities are very 
limited, and apparently no attempt has been made to do any dissecting 
or to arrange for doing it in the near future. The college has no 
hospital of its own, but the students attend cUnics at the so-called 
Tientsin Hospital, a small government institution, not far away, 
which is not well adapted for use as a teaching hospital. 

The Peiyang Medical School 

The Peiyang Medical School at Tientsin, which is supported by 
the provincial government of Chihli, gives probably the best medical 
training of any government institution. It grew out of the teaching 
done by Dr. McKenzie of the London Mission at his hospital, which 
attracted the attention of Li Hung-chang when he was Viceroy of 
Chihli. A government subsidy was given to the school and it finally 
became a recognized official institution. In recent years the French 
government has supplied to the school three professors, detached for 
this purpose from the army and navy. All the instruction, including 
that given by the French professors, is in English. A good working 



14 China Medical Commission 

knowledge of English is, therefore, one of the principal requirements 
for admission, but some knowledge of physics, chemistry, botany, 
mathematics, and physiology is also required. The students come 
from Chinese government middle and high schools, and from mission 
schools to a less extent. While the instruction given by the pro- 
fessors is probably good as far as it goes, they cannot do all the 
work that should be done, and the buildings and equipment which 
they have at their disposal do not allow them proper facilities for 
first-class training. Some dissecting has been done at this school, 
but no systematic work in it has yet been arranged for. The gradu- 
ates mainly go into government service, in the railways, army, etc. 

Kiangsu Medical Special College 

The provincial medical college at Soochow, Kiangsu, is only in 
its second year, and it is therefore perhaps not wholly fair to judge 
it. Its five principal professors are Chinese trained in Japan. One 
good feature of this school is that it gives its students a year's 
preparatory work in physics, chemistry, mathematics, etc., before 
admitting them to the medical school proper. The equipment is 
very meager, though we were shown tolerably adequate labora- 
tories for elementary physics and chemistry. One body was 
dissected last fall, but no arrangements have yet been made for 
a regular supply of cadavers. There are at present thirty-four 
students in the first-year class and thirty-two in the preparatory 
department. About $47,000 Mex., or about $22,000 gold, per 
annum is the sum said to be appropriated for the support of the 
school. Arrangements are now being made for a hospital to be con- 
trolled by the school. 

Nanchang Public Medical Special College 

This institution has five Chinese professors trained in Japan. It 
has at present only one class, containing sixty students who are now 
in their third year. Like the Kiangsu school it provides a prepara- 
tory year with courses in chemistry, physics, and mathematics. 
Ordinary students pay a tuition fee of $2.00 Mex. a month and 
board themselves, but some w^ere taken over from a former military 
school and are not charged any fees. The provincial government 



Western Medicine in China 15 

grants a subsidy of $700 Mex. per month or about $3,850 gold per 
annum. There is very little equipment, and students get their 
clinical training in a small private hospital of twenty beds. 

Chekiang Medical Special College 

We did not hear of the existence of this school until we were about 
to leave China, and have therefore no information about it. 

Wuchang Medical Special College 

The private medical college at Wuchang had, when we saw it, 
only one class under instruction and its faculty was inadequate, 
including, besides one missionary physician who lectures in anatomy, 
a Chinese instructor in physiology, who was graduated from a defunct 
military medical college, and a Chinese instructor in hygiene, 
who was formerly an assistant in the London Mission Hospital. 
Chemistry, physics, and mathematics are taught by non-medical 
men. The school has as yet no hospital connections and practically 
no laboratories, nor has it any very definite plans for obtaining the 
additional instructors required. The standard also is very low, 
graduates of higher primary schools being admitted. There are 
eighty students in the school this year, all of whom receive their 
tuition, board, and lodging free. It is unlikely that this school will 
long continue to exist unless it receives some support from the 
provincial government or is taken over by it. 

Canton Medical Schools 

While the Kung Yee Medical School belongs to a private Chinese 
association, it owes what success it has had largely to foreign co- 
operation, and it is therefore discussed elsewhere. The Kwong 
Hwa Medical School, on the other hand, is entirely Chinese. Of the 
professors one was graduated at the University of California and 
another at the Hongkong Medical College. There are some fifteen 
instructors in all, though most of the work is done by five of 
them. As at the Kung Yee Medical School, it is hoped eventually 
to insist that all candidates for admission have a preparation equiva- 
lent to that of middle school graduates, but it is difficult to get many 
students so qualified, and as the institution depends on tuition fees 



16 China Medical Commission 

for its support a considerably lower standard has been accepted for 
the present. The tuition fee is $80.00 Mex. or about $37.00 gold 
per annum. At present there are 115 students, including fifty 
women. The course is now four years, but it is planned to lengthen 
it to five years. There is very little equipment for teaching. For ex- 
ample the department of pathology has only one microscope. Dis- 
section is not yet being done in Canton, but we were interested to 
learn that the students are sent to the summer course in anatomy 
offered by Hongkong University, where they are given ample oppor- 
tunities for dissection. A hospital of some forty beds is attached to 
the school. While the building was ill adapted for use as a hospital 
and was of course deficient in equipment, it looked remarkably neat 

and well kept. 

Military Veterinary School 

Mention may be made here of the Military Veterinary School 
maintained by the central government at Paotingfu in Chihli Prov- 
ince. This school has two Japanese professors and four Chinese pro- 
fessors who were trained in Japan. The Director is a graduate of 
the Peiyang Medical School, and seems to be highly regarded by the 
foreigners in that vicinity. There are now seventy-two students in 
the school in two classes. The course lasts four years but there are 
no first or fourth year students at present. This institution, though 
small, made a rather pleasant impression on account of its neatness 
and its facilities for doing practical work, including operating and 
dissecting rooms, animal houses, etc. The students in this institu- 
tion are supported by the Department of War and are intended to 
become military veterinaries. The annual appropriation for its 
maintenance is said to be about $54,000 Mex. or about $25,000 gold. 

Conclusion 

Chinese government and private schools of all kinds have been 
laboring under great disadvantages during the last four years, on 
account of disturbed political conditions and the financial straits 
in which the government has found itself. The extent of the inter- 
est which the Chinese medical schools have aroused in the student class 
is, however, worth noting. In the schools which we have described 
(excluding students of pharmacy and veterinary medicine) there are 



Western Medicine in China 17 

enrolled 657 students, and in many cases we have been told of large 
numbers of candidates for admission being rejected. While in some 
few schools the enrollment is artificially stimulated by the free tuition, 
board and lodging offered, it is fair to say that the practice of medi- 
cine is already being regarded by many students in strictly Chinese 
schools as a dignified occupation for which they would like to prepare 
themselves. 

The government control supposed to be exercised over insti- 
tutions calling themselves "special colleges" is still incomplete. 
For example the Wuchang school does not insist on candidates for 
admission attaining the standard of middle school graduation. The 
specifying of German as the foreign language to be taught in medical 
schools is unfortunate, since the majority of Chinese students prefer 
English, and are better prepared in that language. It would be 
desirable if the government could be induced to allow English as an 
alternative to German. 

Considering the limited funds at the disposal of the central and 
provincial governments the classes admitted to the schools are 
too large. If the requirements for admission were raised by the 
establishment of a three-year preparatory course, in which thorough 
instruction should be given in one foreign language, preferably 
English, and in the principal natural sciences, much better work 
could be done with no greater expenditure of money than at present. 
It would undoubtedly be advantageous also to combine some of the 
schools, as for example the three institutions at Tientsin and Peking, 
though there might be some practical difficulties in effecting such a 
combination. 

The Chinese medical schools are greatly handicapped by the fact 
that not one of them has access to a really satisfactory hospital. 

III. 3 

MISSIONARY MEDICAL SCHOOLS 

Missionary medical work in China originated in the form of 
dispensaries and hospitals — at first on a small scale, then gradually 
extending until they are found in nearly every province, in all the prin- 
cipal cities, and in many small places. The necessity of having native 



18 China Medical Commission 

assistants led inevitably to undertaking the training of young men 
for such purposes. From this it was only a step to undertaking the 
education of some of these young men by hospital physicians in 
medical science. Thus gradually were developed a number of medi- 
cal schools, varying very widely in their equipment and other facili- 
ties, but agreeing in their fundamental purposes of training Chinese 
young men under Christian influences to be medical practitioners. 

At the outset the missionary enterprise aimed only at the propa- 
gation of the Christian faith among non-Christian peoples. At 
first thought it is surprising to find the missionary societies now 
embarked not only in a religious propaganda, but as well in large 
educational and eleemosynary undertakings, hospitals, asylums, 
schools, colleges, and universities. In short, the missionaries are 
trying to provide for China in these lines, at large cost of money and 
men, what western nations do for themselves, either at the public 
charge or from individual beneficence. As the missionary of the 
gospel is not necessarily an educational expert or a trained admin- 
istrator of educational or scientific activities, and as the funds avail- 
able for such purposes are always at best scanty and are divided 
among many independent organizations, it can hardly be expected 
that a systematic and comprehensive scheme should have been 
worked out. Moreover, the justification for putting missionary effort 
into such distinctly lay forms of beneficence depends on a wholly 
new conception of the nature and purpose of the missionary cause — 
the conception that it is the function of the missionary to carry to his 
field not the Christian religion alone, but as well all the finer ele- 
ments of modern civilization. To be sure there are many yet who 
regard humanitarian work of any kind as merely a means of getting 
a hearing for evangelical preaching. Still, the main question is 
practically settled, and missionary societies generally have assumed 
frankly the great duties involved in the extensive educational and 
humane activities which have been set going in China. Occasional 
echoes of dissent are heard, but on the whole the question may be 
regarded as closed. 

The need of co-ordinating the educational work of the various 
missionary bodies could not long be ignored, and efforts were made 
accordingly. Educational forces were united so as to form union 



Western Medicine in China 19 

institutions, and educational associations were formed for the dis- 
cussion of questions of common interest. The Medical Missionary 
Association of China is one of these organizations. With some five 
hundred^ members from all parts of the Republic the Association 
is able to take large views of what is best for China as a whole and 
has already been of marked service. One of its most useful activities 
has been that of recording its opinion on policy with regard to the 
development of medical education. At the meeting of 1913 it was 
strongly urged that no new medical colleges be started in China until 
proper provision in staff, buildings, and equipment should be made 
for the most promising of the schools already existing. A list of nine 
institutions was adopted as those for which provision should first be 
made. The following recommendations are also of importance : 

''Entrance Requirements. For the present the minimum entrance 
requirements for a medical college should be a Middle School pass, 
but ultimately the minimum should include at least two years of the 
College Course, and a foreign language should be one of the com- 
pulsory subjects. 

"Note. This terminology is to be understood in terms of 
Chinese grading, the Middle School being that which follows the 
Lower and Higher Elementary Schools; and the college course that 
which follows the Middle School." 

The list of schools approved includes those at Moukden, Peking, 
Tsinanfu, Chengtu, Hankow, Nanking, Hangchow, Foochow, and 
Canton. Of course these recommendations are to be taken as 
addressed to the various missionary bodies. 

Schools of medicine in the cities named are conducted by a union 
of various missions, under agreements varying in their details with 
the particular circumstances of the case. 

Besides the schools above named those in Shanghai and Changsha 
are worthy of careful consideration. That at Tsingtau belongs to 
the German Government of that Colony, and that at Hongkong to 
a corporation chartered by the British Government. 

Within the above will be found all the medical schools worthy of 
notice which are not controlled by the Chinese government. 

1 Four hundred seventy active members and fifty-four corresponding and 
honorary members in 1914. 



20 China Medical Commission 



Moukden 



The Moukden Medical College dates in its inception from 1908. 
It was opened for instruction in March, 1912, with forty students. 
The property belongs to the United Free Church of Scotland, which 
has final authority on financial matters. The management of the 
college is in the hands of a Board consisting of representatives from 
the College Senate, and from the Mission Councils of the three Mis- 
sions in Manchuria — those of the United Free Church of Scotland, 
the Irish Presbyterians, and the Danish Lutherans. A representa- 
tive may also be appointed by the Chinese government. The college 
is not chartered. Appointments to the staff are made by the United 
Free Church of Scotland, or by the mission supporting the missionary 
in question, in consultation with the Board of Management. 

Land used and to be used for medical college purposes amounts 
to nearly six acres. The college building erected in 1912 is of four 
stories, and is devoted to lecture rooms and to laboratories. Its 
cost was about £4,000 ($20,000 gold). There has recently been 
completed a dormitory to accommodate one hundred twenty per- 
sons, and there are four dwelling houses for the staff. The sum 
of £ 1,645 was given for the dormitory, but more will be required 
for its completion. 

The total expenditures for current expenses for the year 1913 
were £ 1,930. This does not include salaries paid by the missions. 
The main source of income is special gifts. Students' fees for 1914 
are estimated at about £420. 

The staff consists of seven foreign medical men, besides a chemist 
and lecturers. The staff give full time to the college and hospital. 
There are eighty students, whose preparation covers the course 
of a Chinese government middle school or of a missionary high 
school. Instruction is in Chinese, but English is taught: "It is 
expected that a good many of the Seniors and a still larger number 
of the Juniors will be able to have their final practical examinations 
largely in English, and to read English medical literature." The 
course of study covers five years. The first students are expected 
to graduate in 1917. Students' fees are $72. 00 Mex. a year. 

The University Hospital belongs to the United Free Church of 
Scotland and is operated by that body. The building, which cost 



Western Medicine in China 21 

approximately £6,500, has 140 beds, and is used as a means of 
clinical instruction for the college. There have been considerable 
contributions from Chinese officials and from private persons. 

Peking 

The Union Medical College at Peking is controlled by a Board of 
Managers elected by the local bodies of six missionary organizations 
— the London Missionary Society, the American Presbyterian Mis- 
sion (North), the American Board of Commissioners for Foreign Mis- 
sions, Peking University (American Methodist Episcopal) , the London 
Medical Missionary Association, and the Church of England Mission. 
There is no charter, but the college is recognized by the Chinese 
government as a medical college and registered as such by the Board of 
Education (i.e., the Ministry of Pubhc Instruction). The Board of 
Managers nominally appoints to the staff, but practically the power 
of appointment rests with the several missions concerned. It is 
expected that the College will become a part of the reorganized 
Peking University. The title to the property valued at $131,900.00 
gold is vested in the London Missionary Society. There are five 
buildings, one for college work, a dormitory, a hospital for men, 
a hospital for women, and an out-patient department. 

The total expenditure for current expenses for the college and 
hospital for the year ending June 30, 1913, was $46,988.71 gold, 
including all salaries. The total income for that year was $48,058. 89 
gold, of which $30,037.71 came from the missionary societies and 
$6,897.80 from the Chinese government for services rendered. 

The staff consists of fourteen foreign medical men giving full time 
to school and hospital, besides lecturers and assistants. There are 
ninety-five students in the college and forty-three doing preparatory 
work. The course covers five years. The requirements for admis- 
sion cover practically the education of a Chinese middle school or of a 
missionary secondary school. A preparatory year is offered. Instruc- 
tion is in Chinese (Mandarin). Textbooks are in easy "Wen Li," 
the written language which is used throughout the whole country. 

Clinical practice is afforded by the Men's Hospital, 60 beds, and 
the Women's Hospital, 30 beds. 

There have been thirty-eight graduates, the first in 1911. 



22 China Medical Commission 

Tsinanfu 

The Union Medical College at Tsinanfu is the medical department 
of the Shantung Christian University. This institution is formed by 
a union of the American Presbyterian, English Baptist, and Church 
of England Missions. For the four departments of the University 
the Presbyterians furnish nine professors, the Baptists six, and the 
Anglicans one. Title to the property is vested in the Baptist Mis- 
sionary Society of London, which has provided nearly all the build- 
ings. The University is not incorporated. The value of the entire 
plant of the University, including fifty acres of land and all the 
buildings, academic and medical, is estimated at $207,215 gold. 
The new hospital in this estimate is placed at $10,000. 

Appointments to the staff are made by the University Council, 
either on recommendation of the missions or with their approval. 

The buildings comprise a college lecture and laboratory building, 
a hospital for one hundred patients (under construction), an out- 
patient department (under construction), dormitories for forty-eight 
students, with residences for the staff, and some minor structures. 

The current annual income is estimated at $7,900.00 Mex. 
besides salaries, $5,460.00 gold, paid by the missions. This may 
be held equal to a total of approximately $20,000.00 Mex. or 
$9,000 . 00 gold. The expenses will balance income. The completing 
of the new buildings will add further expense. The main source of 
income is two societies — the American Presbyterian (North) and 
the English Baptist. 

The staff comprises five foreign medical men and a foreign nurse. 

There have been forty-six students during the year 1913-14, of 
whom it was expected that seven would be graduated in June — 
the first graduates of the college. 

The requirements for admission cover the course of a Chinese 
middle school or a missionary high school. There is a preparatory 
year, and a five-year medical course. Instruction is in Chinese. 

Nanking 

The Nanking Medical School is the medical department of the 
University of Nanking. This institution was formed by a union of 



Western Medicine in China 23 

the work of the Board of Foreign Missions of the Methodist Episcopal 
Church, the Foreign Christian Missionary Society, and the Board of 
Foreign Missions of the Presbyterian Church in the United States 
of America. It is incorporated under the laws of the state of New 
York, three trustees being appointed by each of these three bodies. 
Other missionary organizations may be admitted by the Board of 
Trustees, with suitable representation. One trustee is appointed, 
in accordance with the last named provision of the charter, by the 
Foreign Board of the Southern Baptist Convention, one by the 
Executive Committee of Foreign Missions of the Presbyterian 
Church in the United States of America South, one by the Board of 
Foreign Missions of the Methodist Episcopal Church South, and 
one by the American Baptist Foreign Missionary Society. The 
Board at present is thus composed of thirteen members, and repre- 
sents seven church organizations in the United States. All property 
of the University is held by this Board of Trustees. A Board of 
Managers on the field is composed in a similar manner. The Presi- 
dent of the University is appointed by the Board of Trustees. 
Appointments to the staff of the hospital are made by the Faculty 
of the Medical School subject to the approval of the Board of 
Managers. 

The land at present held and available approximates fifteen 
acres valued at about $53,230.00 Mex. Buildings now used or 
immediately available are estimated to be worth about $93,550.00 
Mex. These, excepting a few residences, are all old and most of them 
will have to be replaced. The hospital equipment is valued at 
$7,225.00 Mex. Thus the total value of the present plant may be 
considered to be about $154,005.00 Mex. or $69,302.25 gold. 

The current expenditures of the school and hospital may be 
estimated at approximately $16,660.00 gold. This includes the 
salaries of five medical men. Three will soon be added for the hos- 
pital. The staff therefore will include eight foreign medical men, 
with a foreign woman as superintendent of the hospital. Chinese 
resident physicians and assistants all give full time to the school and 
hospital. Ten students were graduated in 1914, and fifteen are 
now in the school. Eighteen in the high school are preparing to 
enter the medical school. 



24 China Medical Commission 

The requirements for admission cover the course of a secondary 
school — a Chinese middle school or a missionary high school. There 
is a preparatory course of one year and the medical course includes 
five years. Instruction is given in Mandarin, but some technical 
terms are given also in English. 

The present school was organized in 1910 as the East China 
Union Medical School, which became the medical department of the 
University in 1913. 

Foochow 

The Union Medical College at Foochow dates from 1911 as the 
Foochow Medical School of the Church Missionary Society. In 
1914, by agreement of this society with the American Board and the 
Board of Foreign Missions of the Methodist Episcopal Church a 
union college was formed, under joint management. The Church 
Missionary Society and the American Board have each a hospital 
in Foochow. 

The plant is the property of the Church Missionary Society, and 
comprises a building for lectures and laboratory work with some 
dormitories. Land and buildings are estimated to be worth $6,000 
gold. The total amount desired to complete the plant and equip- 
ment is estimated at $21,575 gold. The staff comprises five foreign 
medical men, paid by the respective missions. Three more it is 
thought will be needed as the college increases in numbers. There 
are eighteen students at present, and plans for extension call for 
dormitories to house sixty. The fee is $50 Mex. This is supposed 
to cover light, laboratory fees, and books to the average value of $14 
a year. The standard of admission is low, including only the end 
of the second year in the middle school. Teaching is in English. 
There is a preparatory course of one year, and the medical course 
covers five years. There should be an abundance of clinical material 
in the hospitals. No arrangements have yet been made to begin 
dissection. 

Hangchow 

The Hangchow Medical School is conducted in connection with 
the hospitals of the Hangchow Medical Mission of the Church Mis- 



Western Medicine in China 25 

sionary Society. The hospitals are well organized and efl&cient, pro- 
viding for about 275 patients. The plan of the medical school is to 
take one class and carry it through a five years' course before taking 
another. There are five foreign medical men on the staff of the 
school and hospitals. There are fifty-six students. Teaching is in 
Chinese and the standard is comparatively low. It is intended to 
have the Nanking University do the first two years of the work, the 
students coming back to Hangchow for their clinical work. The 
plant and management of the school and hospitals are so united that 
separate statistics are impracticable. 

Chengtu 

At Chengtu medical education is projected in connection with 
the West China University, but we are informed that it is not yet 
under way. The Commission did not visit West China. 

Hankow 

At Hankow there is a Union Medical College, the teachers being 
supplied by two English missions, the London Missionary'' Society 
and the Wesleyan Mission. The American Baptist Foreign Mission- 
ary' Societj^ has also co-operated in the past, and a small annual 
grant is made by the China Mission of the Reformed Church in the 
United States. There are three foreign medical men on the staff. 
There are twenty-four students and about twenty have been gradu- 
ated, seventeen of whom are now employed as assistants in various 
missions. The requirements for admission are low — little more than 
a good knowledge of Chinese being necessary. The course is five 
years, and teaching is in Chinese. 

Hankow is an important center of population and business. 
The three cities (Hankow, Hanyang, and Wuchang) have a popu- 
lation of perhaps 800,000. The groups are centrally located and are 
easily accessible by rail and river. Large industries and extensive 
commerce already exist here, and everything points to material 
future growth. An influential official stated that if a medical school 
were established at Hankow it might be possible to secure for it a 
grant of government land. 



26 China Medical Commission 

Canton 

Canton is a great center of Chinese life and the place of the earliest 
business contact between east and west. There have long been 
hospitals under European and American management. Attempts 
at the formation of medical schools to teach western medicine have 
not been very successful. 

There have been several such attempts. 

1) The University Medical School. — In 1904 the Christian Asso- 
ciation of the University of Pennsylvania undertook to carry on the 
medical department of the Canton Christian College. Four medical 
men and a nurse were placed in the field. They acquired the lan- 
guage and taught one medical class, also an excellent body of nurses. 
For various reasons they have thought best to retire from the field and 
have transferred their efforts to Shanghai, where a connection has 
been formed with St. John's University. The property of the Uni- 
versity Medical School, consisting of upward of eight acres of land 
and a small hospital and dispensary building valued altogether at 
$25,000 gold, was left for the use of the Canton Christian College for 
three years, at the end of which time the college may acquire the 
property by purchase. Two of the Pennsylvania staff also remained 
at the Canton Christian College. There is one other physician on 
the college faculty who is available as a medical teacher. 

2) The Kung Yee Medical School and Hospital date from 1909. 
Early in 1908 the Medical School connected with the Canton Hos- 
pital was closed and an attempt to found a medical school for men 
by members of the Presbyterian Mission was not approved by the 
Home Board. In December 1908 Dr. Paul J. Todd interested 
a number of Chinese gentlemen in the establishment of a new medi- 
cal school and hospital under Chinese auspices. The sum of $5,000 
Mex. was raised by the Committee and in the spring of 1909 the 
school was opened. In 1909 a site on the river front was purchased. 
In 1910 subscriptions to the amount of $22,512.29 Mex. were raised, 
and in 1911 a hospital building with accommodations for sixty 
patients was completed. In 1912 the Government gave the insti- 
tution twenty acres of land just outside of the city, and in 1913 gifts 
from private sources amounted to $11,000. Some other land was 



Western Medicine in China 27 

bought. It is planned to raise funds for the erection of buildings on 
the new site and to make the transfer in 1915, 

The Directors of the School and Hospital are all Chinese, There 
are twenty-four members of the Faculty, of whom four are foreign 
medical men. The rest are Chinese, one educated in Edinburgh, 
one in Fort Worth, two in Japan, four in Tientsin, and the remaining 
twelve in Canton. There are one hundred twenty men and thu-ty- 
seven women students. The requirements for admission are low 
— a knowledge of Chinese, some geography, history, and arith- 
metic. It is hoped that graduation from a middle school may in 
time be the standard. Instruction is in Chinese. 

The river front site where the work is now carried on is valued 
at S39,000 Mex, and the buildings at $26,000 Mex, The hospital 
has sixty beds. The land outside the city is valued at $40,000 Mex. 
Total college and hospital equipment valued at $14,699.92 Mex. 
The total assets therefore are placed at $119,699.92 Mex. or about 
$53,865 gold. 

The income for 1913 was $50,623.48 Mex. of which $17,278 
came from fees from male students (the average fee is $100 a year), 
and $8,483.40 Mex. from donations. The expenditures for 1913 
were $50,127.22 Mex. of which $8,500 were for teachers' salaries, 
$1,520.48 for operating expenses of the college, and $18,278.13 for 
the purchase of new land. 

The institution has invited the several missions in and near 
Canton to join with it in a Union Medical School. 

3) The Plan of the Canton Hospital. — This is the oldest hospital 
in China, has a valuable site on the river front, fair buildings with 
three hundred beds, no endowment, and inadequate equipment. It 
belongs to the Canton Medical Missionary Society, of which anyone 
may become a member by paying $10 Mex. Medical instruction 
was formerly given in connection with this hospital but was discon- 
tinued in 1908. It is now proposed to make the hospital the clinical 
department of a Union Medical College for South China. Such 
medical college would have a middle school pass as its basis. 
Instruction would be given in Chinese, but students would be required 
to have a reading knowledge of one European language, English, 
German, or French, before graduation. It was proposed that the 



28 China Medical Commission 

course should be five years and that there should be one year interne- 
ship in an approved hospital before a degree should be granted. At 
the time when the commission left China it was not known whether 
this plan would be carried out. 

4) The Hackett Medical College for Women. — This school, con- 
nected with the David Gregg Hospital, is under the auspices of the 
American Presbyterian Board. There have been sixty-eight gradu- 
ates. The course is of four years, and there are hereafter to be 
two years of preparatory work. There is also to be a year of 
interneship in a hospital. The teaching is in Chinese (Cantonese). 
Two well-trained women have recently been added to the staff, but 
they are engaged in acquiring the language. 

5) The Medical School supported by the French Government 
in connection with the Hopital Doumer is discussed on page 39. 
It is entirely inadequate as a teaching institution. 

Shanghai 

This is one of the most important cities in China, with a popu- 
lation of about 1,000,000. Situated near the mouth of the Yangtze 
River, and with a considerable foreign settlement, it conducts a large 
trade with the interior. The size of the city and the wealth of the 
Chinese who have taken up their residence there, partly for business 
reasons and partly for security of person and property, make it 
clearly an important center for medical education. The abundance 
of clinical material must be beyond question. Thus far, however, 
attempts at establishing medical schools have not met with large 
success. 

The schools are that of St. John's University, which has recently 
made an agreement of co-operative work with the Christian Asso- 
ciation of the University of Pennsylvania; the Harvard Medical 
School; and a German school, which the members of the Commission 
were not allowed to visit. 

The Medical School of St. John's University in 1911 was united 
with the new Harvard Medical School and the work was done 
together, St. Luke's Hospital affording clinical material. This union 
was finally dissolved in 1913 and a new union effected with the 



Western Medicine in China 29 

Christian Association of the University of Pennsylvania. The class 
of five graduates in June, 1914, were joint students of St. John's 
and Harvard. The new union will probably be called "The Univer- 
sity of Pennsylvania Medical School in China, being the Medical 
Department of St. John's University." St. John's will contribute 
four or five men to the staff and Pennsylvania probably two. The 
course will be five years and the requirements for admission two 
years of St. John's College or an equivalent, with stress laid on 
scientific work. The teaching will be in English. St. Luke's 
Hospital (140 beds) will afford clinical teaching. This should be 
a school with good standards, with a good hospital, well-trained 
instructors, and an excellent college to prepare students. 

The Harvard School was opened in conjunction with St. John's 
in 1912. In 1913 on the termination of that agreement, an 
agreement was made for five years with the Red Cross Society of 
China by which the hospital and other buildings of that Society and 
their medical school were turned over to the Harvard Faculty. The 
hospital has fifty-six beds. The Faculty consists of ten foreign 
medical men and one foreign nurse. There is also a business mana- 
ger. Five of the staff give full time to teaching (one of them 
is on leave of absence). Four have a separate income from private 
practice. One was for 1913-14 a member of the Faculty by courtesy, 
being an appointee of the State Board of Health of Oregon. One 
instructor is on half time, teaching the rest of the time in other insti- 
tutions. The special laboratory and hospital equipment in the Red 
Cross buildings is the property of the Harvard Medical School and is 
valued at $13,500 gold. The Harvard Medical School owns a tract 
of land of thirty mow (a trifle over five acres) on which it is proposed 
to erect a new hospital building. A gift of $50,000 gold has been 
made for the purpose. A tract of ten acres of land in the mountains 
at Mokanshan has been given to the school. This will make it 
possible to have summer cottages for the members of the staff. Pro- 
vision has also been made for an out-patient clinic in a congested part 
of the international settlement. 

The budget for 1914-15 plans expenditures amounting to $41,500 
gold for school and hospital. The main source of income is private 
subscriptions. They amounted for the year ending June 30, 1913, 



30 China Medical Commission 

to $32,980.75 gold (including a balance carried over from subscrip- 
tions of the previous year, $2,036.80). 

The requirements for admission are the completion of the middle 
school and at least two years of college work, including chemistry, 
physics, mathematics, and English. The course is five years. 
Instruction is wholly in English. 

There were twenty students in 1913-14 — five in the fifth year, 
under the joint instruction of St. John's and Harvard, none in the 
fourth year, six in the third year, six in the second year, and three 
in the first year. 

Under the terms of the agreement with the Red Cross Society, 
fifteen appointees of that Society have instruction without tuition 
fees. There were twelve such appointees in 1913-14. No tuition 
was charged the five St. John's students. The tuition fee is $100 
Mex. and the dormitory charge $75 per year. 

Changsha 

Changsha is the capital of Hunan Province and has a population 
of about 250,000. It is reached from Hankow by steamer on the 
Yangtze and Siang Rivers in forty-two hours. The projected rail- 
way connecting Hankow and Canton is to pass through this city. 
Of this railroad seventy-three miles have been completed at the 
Canton end and thirty-three miles south from Changsha. There is 
also projected a railway from Kiukiang to Changsha. 

The proposed medical school in connection with the Yale Mis- 
sion — "Yale in China" — is expected to begin its preparatory work 
in the fall of 1914. There will be a medical preparatory course of 
two years, following a middle school course, and a medical course of 
four years leading to the M.B. degree. The M.D. degree will be 
given after a further interneship of at least one year. The Yale 
Collegiate School conducted at Changsha will provide a suitable 
middle school preliminary training. English will be used in the 
medical instruction, but teachers will be able to make explanations 
in Chinese. Premedical work was attempted in 1913, but was given 
up owing to disapproval by the central government of an agree- 
ment between the Yale Mission and the provincial government of 



Western Medicine in China 31 

Hunan for the support of the work. At that time there were four 
hundred candidates for admission. 

A new agreement has since been made which has received the 
approval of the central government. This agreement is between the 
Yale Mission and a group of Hunanese gentry duly registered as 
"The Hunan Ru Chun Educational Association." This Association 
undertakes to provide funds for the medical school under certain 
conditions, and in turn proposes to secure such funds from the 
provincial government. The purposes of the agreement are set 
forth to be to maintain a hospital, a medical school, a school of 
nursing, and a laboratory for research. 

The Hunan Association agrees to provide funds (1) to the amount 
of $156,000 Mex. for school buildings, the buildings and land to be 
the property of the Association; (2) up to a maximum of S50,000 
Mex. a year for the running expenses of the two schools — this 
not to include salaries of teachers who are graduates of western 
universities; (3) the expenses connected with the opening of the 
schools. 

The Yale Mission agrees to erect a hospital at the cost of 
about $180,000 Mex., the building and land to be the property 
of the Yale Mission; to provide the salaries and expenses of 
teachers, physicians, and nurses who are graduates of western uni- 
versities; and to provide the expenses connected with the opening 
of the hospital. 

Jointly the Mission and the Association, pending the erection 
of the hospital and school buildings, are to maintain a medical pre- 
paratory'' course, the school of nursing (male and female), and the 
existing Yale Hospital. Yale provides for teachers and physicians 
who are graduates of western universities, the Association for all 
other expenses up to a maximum of $50,000 Mex. for the two years. 
Provision is also made for a joint Board of Managers. The agree- 
ment is for ten years. 

In the direction of carrying out this agreement, which to be 
binding must be approved by the Civil Governor of Hunan and by 
the Trustees of the Yale Mission, certain things have already been 
done. A gift of $125,000 gold has been made by a Yale gradu- 
ate for the hospital building. On the other hand the Governor 



32 China Medical Commission 

of Hunan has turned over to the Association a large Chinese 
residence and compound in which the premedical work may be 
carried on. 

The plans at Changsha are excellent, with a proper conception of 
what a high grade of medical work implies. The management has 
been exceptionally skillful and the interest of the Hunanese has been 
wisely fostered. There should be developed a strong and useful 
medical school, though in the opinion of the Commission it will be 
essentially a provincial institution. 

General Comments 

Some matters appear at once on a study of the missionary medical 
schools. 

They are recent. Peking opened its doors for instruction in 
1908, the first class being graduated in 1911. Tsinanfu graduated 
its first class, seven students, and Harvard-St. John's its first class, 
five students, in 1914. Nanking began work in 1911 and Moukden 
in 1912. The Kung Yee School at Canton was opened in 1909. 
It should be noted, however, that some medical schools have grown 
out of teaching hospitals which had been training hospital assistants 
for many years. 

The number of the foreign medical men on the staff is small. 
Peking with fourteen. Harvard at Shanghai with ten, and Nanking 
with eight have the most. Moukden has seven and the rest five or 
less. 

The number of graduates is of course small as yet. Peking has 
graduated thirty-eight since 1911 and Nanking ten. The schools at 
Hankow and Canton have graduated twenty and forty-five respec- 
tively. Tsinanfu graduated its first class, seven, and Harvard- 
St. John's its first class, five, in 1914. 

The plant is little more than rudimentary. Peking has a valua- 
tion of $131,900 gold, Tsinanfu $207,215 gold, Nanking $69,302 gold, 
the Kung Yee School at Canton, $53,865 gold, and the rest $50,000 
gold or less. 

The cost of maintenance of schools and hospitals including 
salaries is small — that of Peking being $46,988.71 gold, Harvard 



Western Medicine in China 33 

$41,500 gold, Nanking $25,210 gold, Kung Yee $22,867.27 gold, 
and the rest still less. 

Salaries being generally on a missionary basis are small. The 
maximum including all allowances is approximately $1,500 gold, 
but in each of these cases the use of a house is added. The Harvard 
salaries are slightly higher but no house is furnished, and the cost of 
living in Shanghai is much greater than in other places. 

Tuition rates are low, $100 Mex. or less. 

The faculty as a rule give their whole time to the work of the 
school and hospital, the fees from any outside practice being turned 
over to the school. Harvard is the only exception, four members of 
the staff conducting a private practice for their own profit. 

The cost of living is small compared with that in the United States. 
The salaries above named enable the staff to live in reasonable com- 
fort. In Shanghai only is the salary inadequate. A well-informed 
medical missionary stated to the Commission that the cost of food- 
stuffs had doubled in the last fifteen years, and that wages had 
increased from 50 per cent to 75 per cent in that time. Still he 
thought $1,500 gold enough for comfort. It should be taken into 
consideration that in many societies the missionaries have the 
assurance that their families will be taken care of in some way in 
case of their own death or disability. 

The cost of building is much less than in the United States. 
This is due in part to less cost of materials, but mainly to less labor 
cost. Mr. Murphy of Murphy and Dana, New York, the architect 
employed by the Yale Mission at Changsha, estimated that the con- 
struction of a brick building in New York would cost 30 cents per 
cubic foot, and that the same construction in Changsha would cost 
12 cents per cubic foot. Costs would be higher in Shanghai. 

It is evident that there is no medical school now in China which 
is adequately equipped and no school which is adequately manned. 
Some of the schools, however, have really high standards and sound 
ideas, and the advanced men on other faculties have the right 
policies in mind. 

The relative advantages of the different localities and of the 
different existing agencies for medical educational work are dis- 
cussed in detail elsewhere. 



34 China Medical Commission 

The teachers in the missionary medical schools are for the most 
part men who have had good training. They are enthusiastic, con- 
scientious, and devoted to their work. Few of them, however, have 
had any definite preparation for teaching or have become experts 
in any special line. Many have been called to this service after 
years spent in running mission hospitals during which they have 
been overburdened by routine to such a degree that it has not been 
possible for them to keep abreast of the modern advances of the 
profession. In spite of this, the fact that they give their whole time 
to teaching and hospital work helps greatly to increase the efficiency 
of the schools. Even those among them who are admirably adapted 
to teaching, in view both of their training and personality, are quite 
unable to do themselves justice on account of the utter lack of proper 
equipment. Laboratory facilities and sufficient modern apparatus 
for the teaching of the fundamental sciences are needed everywhere, 
and clinical teaching is almost inconceivably hampered by the absence 
of well-equipped hospitals. Under the circumstances it is remarkable 
that some of the schools are doing as well as they are. 

III. 4 

EDUCATION OF WOMEN PHYSICIANS 

Women physicians have played a considerable part in the develop- 
ment of western medicine in China. The Chinese are a conservative 
people and it was a comparatively difficult task to get them to 
intrust women patients to male physicians. Even now many of 
the largest clinics for women are superintended by women physicians. 
In the last few years, however, there has been a great increase in the 
number of female patients in hospitals conducted by men, and at 
present in many localities the women turn to male physicians as 
readily as they would to one of their own sex. This is especially 
the case if there are foreign or native nurses associated with the male 
doctor. It is fortunate that this change in the attitude of the Chinese 
has begun to take place, for almost all the missions report great 
difficulty in obtaining a sufficient number of women physicians. 
This lack of trained medical women willing to work in the mission 
field appears to be more marked in America than in England. The 



Western Medicine in China 



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36 China Medical Commission 

situation is somewhat relieved by a small group of Chinese women 
who have received a medical training abroad. All are doing useful 
work, but two or three of them are unusually efficient, and demon- 
strate definitely that with a proper education Chinese women are 
capable of developing a high degree of professional and executive 
power. 

There are three institutions for teaching women in China. The 
Hackett Medical College for Women was established about fourteen 
years ago in Canton by Dr. Mary Fulton, one of the pioneer women 
physicians in China. The only admission requirement is that 
students shall have a good training in the Chinese classics. The 
course lasts four years. Practically no laboratory work is done at 
present, but laboratory work and two years of preparatory study 
will be required shortly. The teaching is in Cantonese. Sixty- 
eight women have been graduated from this school. 

The North China Union Medical College for Women was estab- 
lished in Peking in 1908. As yet it has only been possible to take 
a new class every two years and only one class has been graduated. 
It is estimated that there will be from twenty to thirty students in 
the school next year. The language used is Mandarin. The course 
lasts five years. Students are admitted who have a college degree 
or a high school diploma, but, failing one of these, they must pass 
examinations in English, Chinese, mathematics, history, geography, 
physics, and physiology. The standard for admission will be 
gradually raised. The equipment and facilities for teaching are 
small, but plans are under way by which they will be considerably 
improved. The faculty consists of five women giving their whole 
time to the school and hospital (two more studying the language), 
one giving part time, and, hitherto, five men of the Faculty of the 
Union Medical College who have given part time. 

The Women's Medical College at Soochow was started in 
1891 by the women of the Methodist Episcopal Church South, 
and holds a charter from the state of Tennessee. For many years 
Dr. Margaret H. Polk was the only physician, but now there are 
nine on the faculty giving whole or part time. The teaching is 
in English and the course lasts five years. Up to the present there 
have never been over four in a class owing to lack of space. The last 



Western Medicine in China 37 

catalogue gives the names of fourteen students in two classes, but 
some of these since have dropped out. The admission requirement 
is a certificate from a mission higher primary school, but candidates 
are advised to study at least one year in a mission high school. 
Applicants without certificate must pass an examination in English, 
Chinese, geography, Latin, physics, and mathematics. There are 
eight graduates of the school. 

In addition to the above mentioned medical schools women are 
studying at the Kung Yee Medical School and at the Kwong Hwa 
Private Medical School in Canton. At both of these there are more 
men students than women, and for purposes of instruction the sexes 
are for the most part kept separate. The time for co-education 
has not yet arrived in China, though it may possibly come in the 
course of the next ten years. 

It will be seen that there are few opportunities for women to 
study medicine in China, that the existing schools are small, poorly 
equipped, ill-prepared to train competent physicians, and that the 
results of their work have been meager. They are hampered from 
the start by an inability to get a sufficient number of girls with a 
proper preliminary education. Until the whole standard of educa- 
tion for girls is raised and until a higher education for women has 
been widely developed, the medical schools will be forced to keep 
their admission requirements low, and to struggle with a poorly 
prepared group of students. It would hardly seem wise to take 
active steps to foster medical education for women until the underly- 
ing educational structure has been considerably strengthened. For 
the present such women as are peculiarly fitted for the profession 
might better be sent abroad for a thorough training. One Chinese 
girl is at present at the Johns Hopkins Medical School. The 
development of medical schools for women will moreover, unless 
admission requirements be high, tend to diminish the importance of 
the nursing profession, and the training schools for nurses will be 
filled with girls who are below the standard of the medical schools. 
At the present time in China high grade nurses are as much needed 
as are women physicians, and it is essential that the nursing pro- 
fession be recruited from girls who are of good social standing, 
and who have received the best possible education. 



38 China Medical Commission 

III. 5 

NON-MISSIONARY MEDICAL SCHOOLS UNDER FOREIGN 

CONTROL 

In addition to the missionary medical schools, and the medical 
schools under Chinese control, both of which have already been 
considered, there are a number of medical schools in China which 
are under foreign control, but are non-missionary in character. 

1. THE JAPANESE MEDICAL SCHOOL IN MOUKDEN 

This institution was not visited by the Commission. It was 
started about three years ago, and is carried on in connection with 
the hospital established by the South Manchuria Railway. Both 
school and hospital are supported by the railway. The hospital 
is planned to have eventually one hundred fifty to two hundred 
beds. When visited by Dr. Cochrane of the London Missionary 
Society, two years ago, there were about sixty patients. He describes 
the hospital as being first-class, with excellent operating rooms, 
obstetrical and dental departments. At that time there were 
no students in the school. It was planned to have a staff of 
about twenty doctors in connection with the hospital and school. 
A knowledge of the Japanese language is one of the entrance 
requirements. 

This school and hospital, being backed by the railway, should 
not lack funds and it is quite possible that they may develop into 
strong institutions. The school will certainly be a worthy rival of 
the Union Medical School in Moukden. The Commission was 
informed in Japan that it was anticipated that some Japanese 
students who failed to gain admission to medical schools at home 
would enroll in the Moukden school. 

2. THE GERMAN MEDICAL SCHOOL AT TSINGTAU 

The Chairman and Secretary visited Tsingtau May 23 and 
were shown every courtesy. A medical school has been planned 
and the preliminary years are in operation. The well equipped 
middle and high schools carry students somewhat further than the 
German gymnasia. There were at the time some three hundred 



Western Medicine in China 39 

Chinese young men in the high school, and the fundamental medical 
sciences were taught by German teachers, using the German language. 
Perhaps thirty of these 3'^oung men desire to become physicians, and 
preparations were under way for their clinical instruction. Within 
the year 1914-15 it was planned to erect a hospital with about 
two hundred beds, and also suitable laboratories. The entire plant, 
hospital, laboratories, and equipment, it was estimated would cost 
approximately $200,000 gold. The war may put a stop to these 
excellent plans. 

3. THE GERMAN MEDICAL SCHOOL AT SHANGHAI 

The Commission tried to visit this school but were informed 
that they could not do so as it was "examination time." The Com- 
mission met several other people who had also been unsuccessful 
in their attempts to see the school. One of the professors in the 
Harvard Medical School at Shanghai has been through it, and 
speaks well of the equipment, but the work is apparently not far 
advanced. In conversing with Professor Kitasato, at the Institute 
for Infectious Diseases, Tokyo, we found that the Japanese had also 
not been welcomed at the school. One of the professors of the 
Institute told us that he had seen the school, but that it was not so 
well equipped as the Harvard School in Shanghai. 

4. THE FRENCH MEDICAL SCHOOL IN CANTON 

This medical school is carried on in connection with the Hopital 
Doumer, an institution supported by the French government, and 
by the government of Indo-China. The course lasts five years, and 
there are at present forty-five students. The requirements for admis- 
sion are a fair knowledge of Chinese, and a little geographj^, arith- 
metic, and writing. The staff of instructors consists of three French 
army surgeons attached to the hospital and one Chinese assistant. 
None of the French doctors speal^ Chinese, so the lectures are 
delivered in French, and translated into Chinese by an interpreter. 
The doctor with whom we visited the hospital was distinctly 
apologetic about the standard of the medical school. 

This is a low grade school, and one of which curiously little is 
known by medical men outside of Canton. It is of verj^ little 



40 China Medical Commission 

importance, either local or general. The fact that it has so many- 
students is of interest as showing how desirous the Cantonese are 
of taking up the medical profession. 

5. THE HONGKONG UNIVERSITY MEDICAL SCHOOL 

With the establishment of the new Hongkong University in 
1912, the work of the old Hongkong Medical School, which had been 
in existence for nearly twenty-five years, was taken over by the 
University, and its lecturers became members of the faculty of the 
new institution. The present school is planned to be of high grade, 
and its degrees are recognized by the General Medical Council of 
Great Britain. The entrance requirements are high, but they are 
rather more adapted to English than to Chinese students. Teaching 
is in English. At the end of a five years' course the degree of M.B. 
is given, and five years later, after doing special work, the degree of 
M.D. may be obtained. There are some forty students and about 
fifteen members of the teaching staff. The professors of anatomy 
and of physiology are both "full-time" men who have come out 
from England within a year. The lecturers on chemistry and 
physics are connected with the department of engineering. The 
professor of pathology is in charge of the government laboratory, 
and has control of the autopsies at the public mortuary. Instruc- 
tion in surgery is given at the hospital of the London Missionary 
Society, but most of the instruction in medicine until lately was 
at the Tung Wah Hospital. The latter is controlled by a Chinese 
Board of Managers, and has on its staff practitioners of Chinese 
medicine as well as western trained doctors. It has a large amount 
of clinical material, but is a most inefficient institution, and entirely 
unfit to be used for teaching purposes. There was talk of remedy- 
ing this defect by opening the government civil hospital to students. 
There is a new and excellently equipped building for anatomy, and 
the supply of bodies for dissection is plentiful. It is hoped to add a 
special wing for physiology. At present the laboratories of pathology 
and physiology are in the University building. Most of the students 
live in the hostels of the University or of one of the missions. The 
total expense per annum for a student is about $650 . 00 Mex. The 
Dean of the School emphasized the fact that this is much less than 



Western Medicine in China 41 

the cost of going to England and that it is planned to give a course 
of study similar to that in English schools. It is, however, much 
more than most Chinese students can afford. 

The advantages and disadvantages of this school, together with 
its probable relationship to medicine in China, are discussed in 
another part of this report. 

III. 6 

LOCATIONS CONSIDERED FOR MEDICAL EDUCATION 

In considering the best locations for medical educational work 
in China we have found the missionaries and others in each of the 
leading provinces deeply impressed with the need of a school in their 
immediate vicinity, and they have been able to bring up very impres- 
sive arguments based largely on the population of their respective 
provinces and the medical needs of the people, as well as on the strong 
provincial spirit which often makes each province seem a separate 
problem. In most cases these arguments have been sufficient to 
convince us that in the abstract it would be highly desirable that 
existing schools should be maintained and strengthened, but con- 
sidering the problem with due regard for the available resources of 
money, of instructors willing and able to teach modern medicine in 
China, and of students qualified to receive such instruction, it 
becomes evident that smaller beginnings are both necessary and 
desirable. Our effort has therefore been to select a few schools so 
located and organized as to have as wide an influence as possible, 
and to afford reasonable assurance that they would give a high 
grade of teaching in the strictly professional studies and also 
foster the high moral standards which are essential for the best 
scientific and humanitarian work. We have been obliged to con- 
sider the suitability of each institution for effective co-operation 
with the Foundation, particularly with regard to its standards, and 
its freedom from interference based on political, sectarian, or per- 
sonal prejudices. The availability and variety of clinical material 
also had to be considered, though in a country like China, with 
an enormous population and almost no hospital facilities, a large 
number of patients can be obtained almost anywhere, once efficient 



42 China Medical Commission 

medical assistance is offered. Besides there are the important 
considerations of existing assets in the form of buildings, land, and 
equipment, the availability of qualified students who wish to study 
medicine, the good will and standing of the school, and the extent 
to which it has secured Chinese co-operation. Institutions which 
have the advantage of intelligent Chinese assistance, through 
Chinese representatives on local boards of control, and the ap- 
pointment of qualified Chinese to responsible executive and teach- 
ing positions, should be encouraged, since through the gradual 
extension of such participation the Chinese will be prepared 
eventually to take over themselves the burden of supporting and 
administering such institutions. One of the great advantages of 
the larger cities is that already a number of well educated, public 
spirited, and reliable men, with modern ideas, can be found in them 
to fill such positions of trust. Their advice and support are often 
invaluable. 

We may begin by considering the northern medical schools. 

Moukden 

Moukden, though it is the political center of Manchuria, i.e., the 
three Eastern Provinces, Fengtien, Kirin, and Heilungchiang, has 
little commercial significance. Its population is only about 180,000. 
Furthermore a large part of the population of Manchuria consists 
of emigrants from Shangtung and Chihli who are still attached to 
their native places and in some cases keep their families there. 
This in part accounts for the fact that there is comparatively little 
of the strong provincial spirit that exists elsewhere in China. The 
people are accustomed to travelling and move about a good deal. 
This district, compared with other provinces, is remarkably well 
served with railways, and in winter the cart roads are in sufficiently 
good condition to make access to the railways comparatively easy. 
Peking can be reached in one day from Moukden by express, and in 
ordinary trains by two days travel from sunrise to sunset. The 
language is practically the same in Peking and in Moukden, with 
the exception of very unimportant provincial variations. For this 
reason most of the students at Moukden could easily go to 



Western Medicine in China 43 

Peking for their medical training and it seems therefore useless to 
undertake a separate medical educational work in Manchuria under 
present circumstances when the number of qualified students 
throughout the country, and the resources in men and money for 
maintenance of the schools, are so limited. This is also the opinion 
of many of the leading medical missionaries in China. Another 
reason for this conclusion is the fact that the Japanese govern- 
ment, acting through the South Manchuria Railway Company, a 
government-controlled corporation, has established there what seems 
likely to be a fairly efficient medical school. 

The hospital around which the mission school has grown up has 
a fine record, notably for the services of its doctors in the Russo- 
Japanese war and during the plague epidemic of 1910-11, and it has 
received Chinese support to an unusual extent. 

Peking 

Peking impressed the Commission as being on the whole far the 
best location in all China for a strong and influential medical school, 
and we have found this view shared by practically all the medical 
men with whom we have consulted on the subject. In the first 
place, it has been the capital of the country almost continuously, 
under three dynasties and under the republic. It seems likely that 
it will continue to be so even if great political changes should take 
place in the country. The population of Peking is variously esti- 
mated, the most conservative placing it at 500,000. 

Being the capital, Peking is the educational center of the country, 
the seat of the Department of Education, which, following German 
and Japanese models, is trying to control the educational policy of 
the whole country. There, also, are located the highest government 
schools. It therefore offers opportunities for influencing the educa- 
tional as well as the administrative oflicers of the government to 
an extent that cannot be equalled anywhere else in China. On 
account of the added prestige which comes with a degree from a 
school in the capital, students flock to Pekmg from all parts of the 
country. It is easily accessible by rail or by sea from most of the 
important cities of the northern provinces of Manchuria, Chihli, 



44 China Medical Commission 

Shantung, Shansi, and Honan and even from Hupeh. Other roads 
already contracted for will bring it into comparatively close touch 
with Shensi, Kansu, and even Szechuan. 

While the claim of Peking residents, that the best Mandarin 
is spoken there, is disputed by other parts of the country, the Peking 
dialect nevertheless has been that of the ruling classes for hundreds 
of years, and it can be understood by practically all educated people 
throughout the northern and interior provinces, in all of which 
Mandarin prevails in one form or another. Many parents in non- 
Mandarin-speaking provinces like Kwangtung and Fukien and in 
Chinese colonies abroad are glad to send their sons to schools in 
Mandarin-speaking districts where they can learn to use the language 
which they will need if they ever enter official life or if they wish to 
travel or live outside their native province. 

The Union Medical College at Peking, while its organization is 
not wholly satisfactory, appears to be more firmly established and 
better supported than any other missionary institution in the 
country. It has the largest faculty, and more students and gradu- 
ates than any other. Some of the professors should from their 
records be well qualified for useful work as teachers of medicine, and 
its new hospital should do a great deal to establish a high standard 
of hospital practice in China. 

This school has one most important advantage which is not 
enjoyed by any other missionary school in China, in that it is recog- 
nized by the Chinese government. Hitherto its graduates have 
received a government diploma in addition to the school degree, 
but hereafter the seal of the Board of Education will be afl^ed to 
the diploma issued by the college. In the plague epidemic and in 
the revolution of 1911 professors and students of this school did 
most useful and even heroic work, and this fact has still further 
strengthened its position vis-a-vis the government. It receives a 
considerable annual contribution from various government offices, 
mainly in return for services rendered by its professors, and some 
years ago was even honored by a present from the Empress Dowager. 

While its equipment is extremely meager, it has an excellent 
site on one of the principal streets of Peking, and several buildings 
that will be useful for many years to come. Its inclusion in Peking 



Western Medicine in China 45 

University, which is now being planned, will remedy some of the 
present defects in its organization by centralizing the control of its 
policy and its property in an incorporated body, the main interest 
of which will be educational. 

For all these reasons the Commission feels that it is most impor- 
tant that a strong medical school should be maintained at Peking, 
and that, if possible, the very creditable beginning made by the 
missionary societies, and their experience, should be utilized by 
assisting their institution instead of founding a new one. 

Tsinanfu 

Tsinanfu is the capital of Shantung province and is said to have 
a population of about 100,000. The Union Medical College there, 
like that at Moukden, is essentially a provincial institution, and while 
Shantung is one of the important provinces of China, with a 
very numerous and industrious population, and with a history of 
which its people are justly proud, in view of the resources available 
the subsidizing of a medical school there does not seem justifiable at 
present. The missions which support this school, the American 
Presbyterian and the English Baptist, would do better to turn their 
students to Peking. As at Moukden a very creditable beginning 
has been made, but its staff and equipment are inadequate, and 
there is grave doubt whether a sufficient number of teachers can be 
secured. 

Nanking 

Nanking has been at various times the capital of China, and 
even for a few weeks the capital of the unrecognized Republic. 
Prior to the revolution, it was the seat of the Viceroy who had juris- 
diction over the lower Yangtze, and it is now the capital of the 
province of Kiangsu, but it does not enjoy the same pre-eminence 
as most provincial capitals in China, since commercially it is over- 
shadowed by Shanghai and even by Chinkiang, while Soochow, the 
former provincial capital, shares its political prestige and surpasses 
it in wealth. Though the walls of Nanking inclose a vast area, a 
large part of it is unoccupied except for agricultural purposes, and 
the total population is estimated at only 350,000. Geographically 



46 China Medical Commission 

itspositionis very advantageous; it is centrally located; the Yangtze 
makes it easily accessible from all river ports and from the ocean; 
and now two very efficient railway systems give rapid communica- 
tion with Tientsin and Peking as well as with Shanghai. Other 
railways that will soon be built, if world financial conditions permit, 
will connect it with the interior of Kiangsi and Hunan on the one 
hand and with Honan on the other. 

It is still too early to foretell what will be the effect of this increase 
in transportation facilities, but it seems likely that Nanking will 
increase in importance, even if it does not threaten the commercial 
leadership of Shanghai or take the place of Hankow as a depot for 
the products of the upper Yangtze. Probably all three places will 
continue to develop, for there is enough potential trade in the Yangtze 
valley for all of them. 

The most satisfactory feature of the medical school at Nanking 
is that it is already organized under an American corporation as a 
department of the Nanking University, and thus possesses an 
identity of its own. There is danger, however, that the school may 
be hampered by the retention in the constitution of the local board of 
managers of the principle of denominational representation and con- 
trol. A body composed of the same elements but chosen in some 
way which would allow the members to vote entirely according to 
their own best judgment would probably prove more helpful in 
constructive work. 

Foochow 

Fukien province presents an interesting situation because of 
the great number of dialects in use there which forced the faculty 
of the Union Medical College at Foochow to adopt English as 
the medium of instruction. Like Canton, both its geographical 
situation, isolated from the other leading provinces in China, 
and the difference in language between it and the rest of the country 
make it seem a problem in itself. The number of students prepared 
to study in English is relatively large, as missionary educational work 
has been carried on in Fukien for a long time, and it would therefore 
not be impracticable for men to be sent to a medical school teaching 
in English at Shanghai or Canton. The increased expense necessary 



Western Medicine in China 47 

to send mission students to one of those cities would be more than 
compensated by the saving in salaries and other running expenses 
through the closing of the school, which now lacks the necessary- 
resources in men and money for doing efficient work, and has little 
hope of getting them. While eventually there ought to be a strong 
medical school at Foochow, the Commission does not consider it 
essential that one should be maintained there now. Although 
Foochow is an open port, it is commercially on the decline, partly 
because the city itself is not accessible to anything larger than a 
steam launch, and partly because with the conquest of Formosa by 
the Japanese it lost its hold on the Formosa tea trade, for which it 
was formerly the principal market. Its population is still large, 
however, being estimated at over 600,000. 

Hangchow 

Hangchow, the capital of Chekiang province, with a population 
of about 350,000, where the Church Missionary Society has a small 
medical school, is another place of purely local importance. As that 
mission has agreed that its students should go to Nanking for the 
first two years of their work, this institution does not call for further 
consideration. 

Chengtu 

Chengtu is the capital of Szechuan province and has a population 
of about 500,000. The proposal for medical educational work there 
makes a strong appeal on account of the large population of that 
province, its wealth and its comparative isolation, which renders it 
exceptionally difficult for students to go to other parts of the country 
for their education. Nevertheless any school there would be essen- 
tially a provincial one, and the Commission believes that it would 
not be wise for the Foundation to undertake to assist such an insti- 
tution until the more important schools are well started. 

Hankow 

Hankow seems certain to become a very important city on 
account of its situation on the Yangtze at the head of navigation 



48 China Medical Commission 

as far as ocean steamers are concerned, at a point where many rail 
and water routes converge. The Peking-Hankow railway already 
gives good connections with Honan and Chihli, while the Yangtze 
River and its tributaries, the Han, Siang, and Kan, connect it with 
the principal cities of Hupeh, Hunan, and Kiangsi, as well as with 
the other large cities of the lower Yangtze to the east, and with 
Szechuan to the west. The Canton-Hankow railway now under 
construction will bring Changsha within a few hours of Hankow, 
and will make it possible to go through to Canton in less than two 
days. The Hankow-Szechuan railway, on which work has also been 
begun, will do as much for many interior cities of Hupeh and 
Szechuan which can now be reached only after weeks of hard 
traveling. 

Here is located the great plant of the Han-Yeh-Ping Iron and 
Coal Company, the largest industrial enterprise in China, with many 
other important modem factories, both foreign and Chinese. There 
is a population of upward of 800,000 taking together the three cities 
of Hankow, Wuchang, and Hanyang, which are separated from each 
other by the Yangtze and Han Rivers. Most of the trade is at 
Hankow; Wuchang is the capital of the province of Hupeh and its 
educational center; and Hanyang is the seat of the largest manu- 
facturing industry. This is the strategic center where the revo- 
lution broke out, and from which later the present government 
was able to maintain and strengthen its hold upon the rest of the 
country. 

While geographically and politically Hankow and Wuchang are 
already very important, they are not the center of such a strong 
and enthusiastic provincial feeling as we found at Tientsin in Chihli, 
at Changsha in Hunan and at Canton in Kwangtung. It seems 
also to be more difficult to find there men who are willing and able 
to take the lead on behalf of the Chinese community in large public 
enterprises. The lack of provincial spirit is accounted for in part 
by the fact that in ancient times the province, after losing most of 
its population in bloody wars, was filled up with immigrants from 
neighboring provinces. Later the development of foreign and 
domestic trade brought to Hankow many Chinese merchants from 
the lower Yangtze valley and from South China who have little 



Western Medicine in China 49 

interest in the city except to make their fortunes as soon as possible 
so that they can return to their native provinces. 

The Union Medical College at Hankow has a smaller faculty 
and less equipment in the way of buildings and apparatus 
than any other recognized missionary medical school which we 
visited, though it does have access to hospitals with abundant 
clinical material. Its standards are low. Only two missions, the 
English Wesleyan and the London Mission, neither financially 
strong, are co-operating to an important extent in this school, and 
their representatives have intimated that they would gladly give 
place to any new institution which would be able to carry on the 
work on a proper scientific basis. They have little hope of receiving 
substantial assistance in the near future, for the American Episcopal 
Mission, the only other strong missionary organization there, is 
sending its medical students to St. John's at Shanghai. There is, 
therefore, practically nothing to build upon at Hankow, and to 
undertake work there would practical!}^ mean organizing an entirely 
new institution. This does not seem to the Commission advisable 
at present. 

Shanghai 

As Peking controls the political situation in China, so Shanghai 
dominates the trade and industrial activities of all the central and 
northern provinces. It is true that in recent years the direct trade 
of other ports has been increasing, but nevertheless if the cheap and 
bulky commodities which must go as directly as possible to the con- 
sumer are deducted, it will be found that an overwhelming proportion 
of the foreign trade of China is conducted through the great market 
of Shanghai. There are located some of the greatest Chinese indus- 
trial establishments such as the cotton mills and the Commercial 
Press. There also are the head ofl&ces of large Chinese corpora- 
tions such as the Han-Yeh-Ping Iron and Coal Company, and the 
China Merchants Steam Navigation Company. On account of the 
security of Ufe and property in the foreign settlements and the modern 
conveniences to be found there, Shanghai has become a favorite place 
of residence for retired Chinese ofiicials and wealth}' men. From 
among these men and those with a modern training employed in 



50 China Medical Commission 

commercial, industrial, educational, and official pursuits, strong 
advisory committees and much active support for public enterprises 
can be obtained. So influential is the Chinese community in 
Shanghai that during the revolution of 1911, although the move- 
ment started at Wuchang and the commander-in-chief of the revo- 
lutionary forces, General Li Yuan-hung, continued to live there, the 
negotiations with the Manchu dynasty and the foreign powers were 
completely taken charge of by the Shanghai leaders, and their 
decisions were accepted as final by the country. 

The population of Shanghai is large, being estimated at about 
1,000,000 including the parts under foreign and Chinese control. 
From the point of view of clinical material it is of special interest 
because the large foreign community there gives medical men an 
opportunity to find many cases, both medical and surgical, that are 
at present comparatively rare among the Chinese. The Chinese 
population also comes from many provinces and includes many 
transients, so that the cases are not all of a strictly local character. 
Shanghai is very accessible, being connected by good steamer service 
with all the Yangtze valley and coast ports, and by rail with the 
interior of Kiangsu, Chekiang, and Anhwei as well as with the 
northern provinces. 

The foreign settlements at Shanghai, which contain a population 
of nearly 700,000 of whom some 16,000 are foreigners, have modern 
health departments with provisions for sanitary inspection of dwell- 
ings, factories, markets, etc., quarantine of infectious diseases, 
facilities for routine examination of chemical, bacteriological, and 
pathological specimens, etc. While their control over the Chinese 
residents is not complete on account of legal and sentimental diffi- 
culties, these health departments serve as wonderful object lessons 
to the Chinese in general, and particularly to medical students in 
training for public-health work. The foreign example has had 
a marked effect in improving the manner of constructing and 
maintaining Chinese streets in Shanghai and has also led to the 
establishment of very creditable Chinese cholera and isolation 
hospitals. 

There are in the neighborhood of Shanghai many schools quali- 
fied to prepare students for the study of medicine, and the English 



Western Medicine in China 51 

language, a knowledge of which is essential, is more widely used there 
than elsewhere in China. For these reasons Shanghai seems to be 
after Peking by far the best location for a strong and widely influential 
medical school. 

At present there is no medical school in Shanghai which is estab- 
lished on a really permanent and satisfactory basis. It is true that 
the work now being done by the Harvard Medical School of China 
is excellent. The first students were graduated this year (in co- 
operation with St. John's) and they are very highly spoken of. 
The present equipment for teaching a small number of students is 
superior to that of any other institution that we have seen in China. 
The Red Cross Hospital, which the Harvard School now controls, 
has the best appearance of any hospital we have seen in the east 
outside of Manila, though it is far too small. The school has, how- 
ever, as already noted, no buildings of its own, and the funds for its 
maintenance come mainly from subscriptions pledged for a short 
period which is about to expire. Its financial position is there- 
fore not entirely secure. While the attitude of this school toward 
the missionary movement is sympathetic, it has the great advan- 
tage of being entirely free from religious restrictions. Most of 
the staff have now a good grasp of the medical educational situa- 
tion in China and with their local experience are well qualified to 
become the nucleus of a strong medical faculty. 

The ideal arrangement would be to have all the forces interested 
in medical education in the lower Yangtze valley brought together 
in one strong institution at Shanghai, for at the present stage of 
development one good medical school in that region should be 
suflScient. 

Canton 

Kwangtung is one of the great provinces of China, the first to 
have extensive intercourse with foreigners, and the one from which 
most Chinese have gone abroad, particularly to the United States. 
Cantonese have a reputation for shrewdness and industry throughout 
the country, and they have been very influential, not only in the 
radical revolutionary government, but also in the more conservative 
regime which exists at present. Under the empire also the number 



52 China Medical Commission 

of influential Cantonese in government service was always large. 
The profession of medicine is very highly esteemed in Canton, and 
the number of students now studying medicine is larger there than 
in any other city in China that we have visited. Even poorly 
qualified graduates find the profession very lucrative. The city of 
Canton itself is one of the largest and most influential in China, 
having a population of about 1,000,000, and is at the same time the 
one most subject to epidemics of tropical diseases. The existence 
there of the oldest hospital in China, the Canton Hospital, with a 
wide reputation and wonderful clinical material which it is willing to 
place at the disposal of an efficient medical school, is an important 
asset. 

While there is at present no men's medical school controlled 
by foreign missionaries at Canton, there exists in the Canton 
Christian College an agency which is qualified to undertake such 
work and to maintain it at a high level. The fact that this insti- 
tution is an independent corporation, undenominational and requir- 
ing acceptance of no creed, would greatly simplify co-operation 
with it by the various organizations interested in medical education. 
The school at Hongkong is indeed close at hand, but it is very 
expensive, costing the student about $650 Mex. per year, instead of 
the maximum of about $200 Mex. which would amply cover the 
usual expenses for tuition, board, and lodging of a student in China. 
The important scholarships at Hongkong University are available 
only for British subjects. The admission requirements at Hongkong 
are further unnecessarily high in unessential subjects such as English 
literature. Besides these disadvantages Chinese educated in Hong- 
kong tend to go into British government employ or into private 
practice in one of the British colonies, and it is alleged that they 
become more or less alienated from their own people, or at least less 
adapted to work among them. It does not seem, therefore, that 
Hongkong University meets the needs of South China for medical 
education, and it is certain that as a center from which to influence 
the Chinese government and people it cannot be compared with 
Canton. While Hongkong is making a good beginning there is 
little prospect of its soon giving instruction equal to that in first- 
class schools in England. 



Western Medicine in China 53 

Changsha 

At Changsha, the capital of Hunan province, a city of some 
250,000 inhabitants, the undenominational educational mission sup- 
ported by Yale graduates is working out a most interesting problem 
in co-operation with the Chinese in medical teaching and hospital 
work. Hunan is fortunate in possessing wonderful resources, both 
agricultural and mineral, and the people of the province have 
long been known as among the most independent and energetic of 
the whole country. Even under the empire they did very much 
as they pleased, and while their early isolation led them to distrust 
foreigners, they are in no sense anti-foreign. The medical members 
of this mission, one of whom is a Chinese trained abroad, have been 
very successful in their relations with the Chinese and in matters 
concerning the public health they have been the trusted advisers of 
the local authorities. The Yale Mission feels very strongly the 
necessity of insisting on all reasonable safe-guards for the mainte- 
nance of high standards in its co-operative venture with the Chinese, 
and we believe, therefore, that this experiment, if carried to a suc- 
cessful conclusion, will have most important results in the gradual 
development of a high-grade strictly Chinese medical school, and 
very possibly in the establishment of a model public-health service 
by the natural extension of the influence of the Yale medical men 
at Changsha, both Chinese and foreign. 

in. 7 

HOSPITALS IN CHINA 

The following report is based on the personal inspection of 
eighty-eight hospitals in China and in Hongkong. These hospitals 
are situated in twenty-eight cities (including Hongkong) and in 
ten different provinces. Fifty-nine of the hospitals may be grouped 
as representing the work of twenty-three Protestant missionary 
organizations (including the Harvard Medical School) while four 
are conducted by CathoHc Missions. Twenty-five are wholly non- 
missionary in character and are controlled by the Chinese central 
or local government (ten), by Chinese societies or private individuals 



54 China Medical Commission 

(eight), by the Chinese Red Cross (two), or by foreign organizations 
(five). The latter include the Shanghai General Hospital, the 
International Hospital at Hankow, the Japanese Hospital at Hankow, 
the Dojin (Japanese) Hospital at Peking, and the French Government 
Hospital (Hopital Doumer) at Canton. Two hospitals belonging to 
the Chinese Red Cross Society are classed among the mission hospitals 
(Changsha, Shanghai) as they are being at present conducted by the 
members of the staff of the Yale Mission and the Harvard Medical 
School. In four of the hospitals visited the physicians are all prac- 
titioners of the old style of Chinese medicine. In three others Chinese 
medicine and western medicine are carried on side by side. It is 
quite customary in China to separate completely hospital work for 
women from that for men. Thus it is not uncommon to find in one 
city the work of a single mission being carried on by two staffs in 
buildings which may be at a considerable distance from one another. 
In such instances they have been regarded as separate institutions. 
When, however, the wards for men and women are in the same 
building or in adjacent buildings in a single compound, and are under 
the same general management, the whole has been considered to be 
a single unit. Thus twenty-three of the hospitals visited are for 
women alone, and fifteen are for men alone. The remainder are 
for both men and women. 

A study of hospitals in China resolves itself almost completely 
into a consideration of the mission hospitals. The more important 
of the non-missionary hospitals controlled by foreigners are estab- 
lished for the care of foreign patients and thus have no very definite 
influence on China itself. The hospitals under Chinese control, 
whether government or private, are with few exceptions ineffective, 
and they are chiefly of interest as demonstrating how small an 
impression high grade western medicine has as yet made on China. 
It will, therefore, be proper to present first a somewhat detailed 
analysis of the present conditions prevailing in mission hospitals. 

The Mission Hospitals 

One of the first things that the traveller in China learns is the 
inaccuracy of all general statements. The country itself is so 
enormous, the physical, geographical, social, and political conditions 




THE NEW CANADIAN PRESBYTERIAN HOSPITAL AT CHANGTEFU 

Constructed of native brick 




THE NEW CANADIAN PRESBYTERIAN HOSPITAL AT CHANGTEFU 

Main l)iiilciins with office, pharmacy, and dispensary 



Western Medicine in China 55 

differ so profoundly in the various parts, and indeed in closely adja- 
cent districts, that what may be perfectly true of one city is wholly 
untrue even of its near neighbor. In few fields of activity is this 
more definitely brought home to one than in medical work, which 
by its very nature comes into intimate touch with that most con- 
servative of classes — the common people. Moreover, in a study of 
medical work as it is carried on by foreign missions one soon finds 
that the accuracy of generalizations is limited not only by the 
inherent local factors, but also by the great differences existing 
among the foreigners who control the work. This depends in part 
on the mission body under the auspices of which the work is done, 
but much more frequently on the individual who is in direct charge. 
Thus one doctor devotes his attention chiefly to the development 
of the medical efficiency of his hospital, while another is more inter- 
ested in evangelistic work, and regards the hospital more as a means 
to that end. One man has an executive, business-like mind, while 
in another this may be quite lacking. One man is by nature, and as 
a result of previous experience in his city, a conservative, while 
another is more boldly a progressive. It is a common experience to 
be told that some thing "cannot be done in a hospital in China at 
the present time," and then to find that exactly this thing is being 
done in another hospital only a short distance away. Sometimes, 
of course, the local conditions are different in the two places, but not 
infrequently the difference lies in the doctors themselves. Besides 
the personal element in determining the differences found in medical 
work, there are other facts of importance. Financial support, 
mission policy, size of the staff, whether foreign or native, the pres- 
ence or absence of nurses, and other similar questions all tend to 
diversify the efficiency and standards of different institutions. 
While, then, it is quite impossible to make comprehensive statements 
with regard to mission hospitals in general, a broad survey of existing 
conditions may be drawn, attention being called to the variations 
where they are of especial significance. 

HOSPITAL CONSTRUCTION 

There are roughly two types of hospitals in China, the one con- 
sisting of native houses more or less adapted to their new use, and 



56 China Medical Commission 

the other consisting of buildings especially constructed along western 
lines. The hospitals which are being conducted in native houses 
are almost invariably regarded as being in temporary quarters. 
The old houses are used as a makeshift until land can be purchased, 
and funds obtained for the erection of a new hospital. These 
hospitals usually represent the first step of the entrance of western 
medicine into a new center, and as a matter of fact they serve their 
purpose not wholly unsatisfactorily. The houses are fairly strongly 
constructed of clay or brick, and consist of one-storied buildings 
surrounding a series of courts. They are shut in by a high wall, 
so that even in the middle of a noisy Chinese city they are apt to be 
peaceful and relatively quiet. The courtyards and the customary 
large reception rooms form excellent waiting rooms for the crowds 
that frequent the dispensary. The smaller rooms leading off the 
main apartments can be readily adapted to use as examining rooms 
and dressing rooms. The problem of caring for in-patients is more 
difficult, as the rooms available for wards are usually small, dark, 
and poorly ventilated. Still worse are the facilities for baths and 
lavatories. In the Chinese house this department is of the simplest, 
and it requires both an ingenious and a persistent man to provide 
proper arrangements, and to keep them subsequently in anything 
approaching satisfactory condition. The construction of an operat- 
ing room usually means the rebuilding of some portion of the house 
and even then the result is necessarily rather primitive. Running 
water is rarely to be had in these hospitals, and central heating 
almost impossible. Nevertheless some of these hospitals, and 
especially those in the larger houses, have been quite well converted 
into simple but useful hospitals. The degree to which they are 
adapted, or, more accurately, the amount of money spent on them, 
usually depends on the prospective term of residence in them, and 
on the possibility of replacing them by modern buildings. 

The buildings especially constructed for hospital purposes vary 
of course greatly, depending on the amount of money available, 
the size of the staff, the period of their construction, and other 
factors. The older hospitals frequently consist of a group of build- 
ings, each better than its predecessor and the whole representing the 
growth of the medical work. The hospitals are sometimes situated 




THE METHODIST EPISCOPAL HOSPITAL FOR WOMEX AT 
TIENTSIN (back) 



.'•-''^^i:,* 




THE METHODIST EPISCOPAL HOSPITAL FOR WOMEN AT TIENTSIN 

Small rooms with k'anss suiTouiulinR a court 



Western Medicine in China 57 

in the heart of the city, but more often they are in a compound just 
outside of the city walls, as it is difficult to obtain land enough within 
the city proper. Indeed it is frequently a hard task to get sufficient 
land even outside of the city. The land is usually held in small 
pieces by families, thus necessitating the agreement of many indi- 
viduals before it can be purchased. Inasmuch as most pieces of 
land are encumbered by graves, which the owners are loath to dis- 
turb, the buying of land in China is proverbially a slow process. The 
hospitals are usually two-storied, sometimes three-storied buildings. 
The commonest building material is the native gray brick, which 
gets its color by having water poured on it while it is still in the kiln. 
Native brick is cheap and seems to be a most satisfactory building 
medium.^ Stone and especially wood are rarely used. In some places 
the buildings are of mud, broken stone, and clay or cement. Rein- 
forced concrete, which has proved to be the best building material 
in the Philippines, is extremely expensive in China, and it is almost 
impossible to get workmen in the interior who understand its use 
properly. All the walls of buildings are usually made of solid brick. 
This is covered on the inside with plaster. The floors are most often 
of wood, while in dressing rooms, bath rooms, lavatories, and rarely 
in wards, concrete is used. Sometimes special preparations are used 
on the operating room floors. The walls are usually kept clean 
by frequent applications of whitewash. The wooden floors are 
often covered with "Ningpo" varnish, an unusually heavy and 
resistant material which allows of frequent scrubbing. It is most 



1 Very good buildings constructed of native brick with concrete floors cost 
about $0.15 (gold) per cubic foot in Shanghai and $0.13 (gold) per cubic foot 
in the interior, but some fairly substantial buildings have been built much cheaper 
than this. The Erskine Hospital at Changtefu (see photographs) was built and 
equipped in 1914 at a cost of approximately $8,000 (gold). This includes an 
out-patient block and a main hospital building (forty beds) with operating suite, 
of foreign type; buildings of Chinese type with room for one hundred patients 
on k'angs; an isolation department, and various out-buildings. The land (two 
and one-half acres) on which the hospital is built cost $500 (gold) . 

St. Paul's Hospital for Women and Children at Kaifeng, recently finished and 
well constructed in foreign type, cost $26,000 (Mex.) or about $12,000 (gold) . 
This is a hospital of eighty beds, with quarters for nurses in training, with an 
apartment for the doctor, and with a separate isolation building. Equipment 
cost $3,000 (Mex.) or about $1,370 (gold). 



58 China Medical Commission 

important that all floors and walls should be constructed so that 
they can be easily washed and sterilized, for the habits of many of 
the patients are rather crude in regard to cleanliness. 

The problem of ventilation and heating varies in different parts 
of the country. In the south all hospitals are built with broad 
verandas, and as the wards are practically open most of the year 
round the question is a simple one. In central and northern China 
the climate is intensely hot in summer, while it is damp and often 
extremely cold in winter. The ideal is thus to get a maximum of 
shade and breeze in summer, and a maximum of sun in winter. The 
combination is hard to obtain and the problem, which is sHghtly 
different in each locality, is a very live one in the minds of all who 
are working in or building hospitals. The methods of heating 
vary — hot water, steam, and stoves being used. Running water is 
far from universal as few cities have a proper water system. In 
many hospitals however water has been piped from cisterns to the 
wards, operating rooms, etc., and indeed in some hospitals, even in 
the country, both hot and cold running water have been put in. 

INTERNAL ARRANGEMENTS 

1. Wards. — The hospitals usually have several large wards for 
free patients or for those who pay small fees covering their "rice." 
In addition there are always a number of private wards for one or 
two patients of the better class. Privacy is a thing that the Chinese 
value highly and they will often pay well for it, so that these rooms 
form a considerable source of income for the hospital. The public 
wards contain from ten to twenty beds. They are large enough, 
airy, and well lighted. The general appearance of the wards in a 
Chinese hospital is very variable and depends in part on the doctor in 
charge, and in part on whether there is a foreign nurse associated 
with the hospital. It is almost possible to tell whether the hospital 
has a foreign nurse or not by glancing into the wards. In some 
hospitals the wards are clean and orderly and compare very favorably 
with hospitals in the west. In others, where there is no foreign 
nurse and an inadequate native nursing staff or where the friends of 
the patients are allowed to camp in the wards, the general appear- 
ance is far from satisfactory. 




SOUTHERN METHODIST EPISCOPAL HOSPITAL. KASHIXa 
Building erected in 1911. Two wards of 20 beds each, private rooms, dining-room, 
bathrooms, students' room, and linen room. Size of ground plan, 80X25 feet. Walls 
In inches thick, of gray native l)rick. Cralvanized iron roof. Cost S3, 200 gold. 







J^ 




^ 


'^ ^^^^ 


hi^ 


1 


in 


1 


T 


Tj 


b 


1 


1 1 


1 


1 


1 Qj 


^1 




■ 


^i 


^_ 


^^^^^^^^^H 



SOUTHERN METHODIST EPISCOPAL HOSPITAL. KASHINO 

Building erected in 1911. Dispensary below and operating-room above. Size. 

50X52 feet. Cost .$3,200 gold. 



Western Medicine in China 59 

Hospital beds in China are of every conceivable type and descrip- 
tion, varying from the native k'ang to the latest model of white 
enameled spring bed. One frequently hears it said that the Chinese 
prefer to sleep on something hard and that if they are provided with 
spring beds they will sleep on the floor. This statement is probably 
a part truth, but it usually comes from some one who has never 
tried western beds in his hospital, and those who have introduced 
them frequently say that once the Chinese get used to the new beds, 
they hke them. The most primitive type of bed, the k'ang, which 
is only found in some of the northern hospitals, is similar to what 
is used in the native houses. It consists of a brick platform covered 
with a straw mat. At one end is a fireplace, the flue from which 
passes directly under the bricks on which the person lies, thus 
affording him a warm bed as long as the fire is kept up, and one 
which is hard enough to gratify the most exacting. K'angs are 
of course uncommon and are usually seen in old Chinese buildings, 
adapted to hospital use, but they have also been constructed in at 
least one new hospital which has only lately been opened. Those 
who advocate the k'angs say that they do away with any feeling 
of strangeness that a new patient may have and make him at 
home, and they provide space for many patients who have come 
a long distance and would otherwise be out-patients. Moreover, 
they give room for the patient's family or friends who may come to 
nurse him in case the hospital cannot provide nurses. At best 
however they are but a makeshift and only call attention to the 
crying needs of the hospital. Many hospitals have beds of boards 
laid across two wooden horses. The majority, however, have iron 
beds. Some of them are fitted with springs of the latest model, 
some use board slats, and many a not at all uncomfortable rattan 
or bamboo substitute for a spring. The latter are rather hard, 
but have some spring, are cool, and are easy to clean — always an 
important consideration. 

As regards bedding and the personal clothes of the patients, 
customs differ greatly. In the better conducted hospitals all the 
bedding — mattress, sheets, blankets, or quilts — as well as personal 
clothing, are suppUed to the patient. In these hospitals the patient is 
required to take a complete bath before admission. At the other end 



60 China Medical Commission 

of the scale are hospitals in which the patients supply their own 
clothes and bedding. Lack of money and a lack of nurses are 
usually the cause of such an unhygienic procedure, and the result 
is that the wards and patients present a most unfortunate appearance. 
Between these two extremes lie a large group of hospitals which own 
a limited amount of clothes and bedding, sufficient to provide only 
for those patients who have no bedding at all, or whose personal 
effects are "too dirty." Even in the well run hospitals the condi- 
tions in the private wards are often worse than they are in the 
public wards, for nearly every private patient brings with him one or 
two attendants or members of his family who live in the room with 
him, spread out their bedding and their belongings, and sometimes 
even cook in the room. It is difficult to keep from associating in 
one's mind the dirty bedding and clothing with the unusual preva- 
lence of typhus fever among the foreign doctors in China. Ten 
recent cases have come to our attention, and six of these ended 
fatally — a high mortality from what is undoubtedly in part, at least, 
a preventable disease. 

Cleanliness, orderliness, and neatness in hospital wards can be 
obtained in China, as is evidenced by the fact that they are obtained 
in a limited number of hospitals. They are, however, much more 
diflScult to obtain than in the west, for the patients have no knowl- 
edge of the meaning of cleanliness. The degree to which they are 
obtained in any given hospital depends for the most part on the 
doctor in charge, on at least a certain amount of money which can 
be devoted to the cause, and, what is most important, on the presence 
of a foreign nurse. Many missionary hospitals, in which a doctor 
is working alone without a nurse, present remarkable looking wards, 
but these are the exception, and they represent a heavy burden 
put on the shoulders of an overworked man. Sometimes an element 
which prevents the wards from being at their best is a fear on the 
part of the staff of driving away the patients, if the conditions 
are made unattractive to them, or if their native customs are too 
much interfered with. Not infrequently one is told that it is impos- 
sible to make every patient take a bath as the "Chinese do not like 
baths." The logical answer is that all over China certain hospitals 
have for years made every patient take a bath, and the number of 




WOMAX AXD BABY ON A K AXt; AT THE METHODIST EPISCOPAL 

HOSPITAL AT TIEXTSIX 

On the right is the stove, with stoke hole, and pot for cooking set into the top 




PATIEXTS OX KAXOS AT THE XEWLY COXSTRICTED CAXADIAX 
PRESBYTERIAX HOSPITAL, CHAXtiTEFT 



Western Medicine in China 61 

patients lost l)y such procedure is quite negligible either from a 
medical or an evangelistic point of view. Similarly it is possible, 
although difficult, to have absolutely satisfactory wards provided 
one has the proper staff and equipment, and provided one "keeps 
everlastingly at it." An important factor in the appearance of the 
wards is the presence of the friends of the patients. In a large 
number of hospitals the friends are allowed to be in the hospital all 
day, and in some institutions one friend or attendant may spend the 
night in the ward on the floor. With this dirty mob continually 
coming and going, eating and spitting, it is of course impossible to 
keep the wards properly clean. One is told, however, that the 
Chinese will not come into the hospital unless their friends are 
allowed to come in freely. Also one is occasionally told that 
the more friends that come in with the patient, the more people 
there are to whom the gospel may be preached. The latter is true. 
The answer to the former is that a few hospitals make it a rule that 
patients may see their friends at stated times only, and one of the 
largest hospitals in China has for thirty years allowed friends in the 
hospital only from three to four daily. It is thus possible to 
keep out the families, and once the rule is made and has been in 
force for a time, it will probably interfere but little with the amount 
of work done by the hospital. There is however one thing to be 
said in favor of letting the friends into the wards at all times. In 
many hospitals there is no nursing staff, or there are so few native 
nurses as to make it impossible for them to care for the patients. 
Under such conditions, the patients must be attended by their 
friends. The solution thus lies in making provision for adequate 
nursing. 

In spite of all the difficulties in maintaining ideal wards in China, 
the ideal may certainly be aimed at and frequently approximated. 
The importance of cleanliness and order in hospital wards cannot, 
of course, be overestimated. Not only is this true from the medical 
side but it is perhaps more true from the point of view of general 
education. If the Chinese are to learn what is best in western life, 
if they are to get the instincts of hygiene and sanitation, if the chil- 
dren are to be brought up to be better physically and morally than 
their fathers, then they must begin with cleanliness. And surely 



62 China Medical Commission 

the hospital should be a model teaching institution in this regard, 
impressing its lesson on each person who enters it. 

2. Bath Rooms and Lavatories. — The hospitals are usually pro- 
vided with at least one or two simple but adequate bath rooms. 
Often there is a bath room in connection with each large ward. 
These are generally rooms with a concrete floor and concrete walls, 
provided with a drainage system. In them may be placed tin tubs 
or large earthenware Soochow bath tubs. A small number of 
hospitals are provided with western enameled bath tubs, occasion- 
ally fitted with hot and cold running water. As has been already 
indicated the degree to which bath tubs are made use of varies 
from place to place. In the better run hospitals, and in an increas- 
ing number, each patient is required to take a bath on admission, 
and at least once a week thereafter. 

The lavatories present a difficult problem, as sewage systems 
practically do not exist in China. One finds innumerable methods 
of dealing with the problem. In most cases the floors and partitions 
are of concrete, so that they can be washed down once or twice 
daily. The excreta are collected in buckets or tubs and disposed 
of at least twice daily. In many hospitals the lavatories are screened 
from flies. To keep these lavatories in anything resembling a sani- 
tary condition is a trying task, which requires the utmost patience 
and persistence, but in many hospitals it has been shown that it is 
quite a possible thing to do. 

3. Operating Rooms. — Every hospital is provided with an operat- 
ing room, and in a fair number of hospitals there are separate rooms 
for clean and septic cases. In a few institutions very up-to-date 
rooms have been constructed, with tiled floors and walls. In others 
simpler quarters suffice, with concrete walls, or with wooden walls 
covered with a heavy enamel paint, and the floors finished with 
Ningpo varnish. Practically all, however, are perfectly well adapted 
to their purpose. They can be cleaned easily and completely and 
are arranged so as to have a good light. 

The operating equipment is in most cases fairly sufficient to the 
needs of the work at present. The problem of sterilizing is less 
easy than in western hospitals, as in most places neither gas nor 
steam are available. Oil burners are the common substitute and, 




WARD IX THE SOUTHERX METHODIST EPISCOPAL HOSPITAL. KASHIXG 




WARD AXD XURSES AT THE XEW LOXDOX MISSIOXARY SOCIETY 
HOSPITAL, PEKIXC; 



Western Medicine in China 63 

although less convenient, they are fairly satisfactory. The majority 
of institutions are provided with modern autoclaves. In some 
hospitals, even in the smaller cities, a system of steam heating for 
the operating room and for sterilization has been installed. The 
absence of running water is often an inconvenience in the operating 
room, but in many places a simple system has been put in. 

4. Laboratories. — Practically every hospital has a small room 
set apart for a laboratory. This is equipped with a microscope, 
centrifuge, and the usual apparatus for routine clinical examinations. 
Sometimes much more special apparatus is found. On account of the 
enormous amount of work entailed by the care of the patients, 
however, the laboratories are for the most part but little used. 
Almost every doctor remarked, when opening the laboratory door, 
" I wish I could get more time to work in here — but it is impossible." 
In a few places a man who has an especial interest for laboratory 
or for research work does manage to make time — and the results, 
frequently published in the China Medical Journal, show how 
important it is that this type of work should be fostered. In per- 
haps four or five hospitals in China, outside of the largest cities, 
the examination of pathological tissues is carried on. In prac- 
tically all others the doctor has no means of knowing the 
exact diagnosis of a tumor he may have removed unless he is pre- 
pared to pay for its examination or to ask to have it examined as a 
favor in one of the few pathological laboratories. The latter, one 
does not feel at liberty to do except in unusual cases, so the result 
is that one of the most interesting and stimulating sides of his 
work must be completely neglected. It is quite possible to train 
Chinese assistants as competent laboratory technicians, but even 
this training takes more time than the average doctor can give, 
and often requires a special knowledge that the clinical man does not 
possess. 

5. Kitchens. — The kitchen department of a hospital in China 
is comparatively simple, as everyone eats the same diet — rice, tea, 
vegetables, and a very little meat. As yet no work of importance 
has been done on the subject of adapting the Chinese diet to various 
diseases. Here is an enormous field awaiting the investigator. Per- 
haps the most common method of conducting the kitchen is to 



64 China Medical Commission 

have a chief cook, pay him a definite sum per day per capita, and 
leave the providing to him. He buys the food and hires his assist- 
ants, and usually receives about ten cents (Mex.) a day per 
patient. All but the poorest patients are supposed to pay this 
"rice money" themselves. The hospital kitchens are similar to 
those in native houses, with brick stoves, in the top of which are 
set large pots for the rice and vegetables. One is commonly told 
when visiting a hospital that "of course it is impossible to keep 
a Chinese kitchen clean," and for a long time it must be confessed 
this statement seemed incontrovertible. However, there are ex- 
ceptions, and in a very few hospitals in which the fires are stoked 
from the outside, so that much smoke is avoided, in which the 
cooks are constantly prodded to keep their departments orderly, 
and in which whitewash is used liberally at short intervals, the 
result is that the kitchens are as clean and neat as one could pos- 
sibly wish. 

HOSPITAL DISPENSARIES 

One of the most important features of the hospital is its dis- 
pensary, for it forms the feeder of the hospital proper. Here it is 
that the patients get their first glimpse of the inside of a foreign 
hospital. Sometimes a separate building near the gate is available 
for use as an out-patient department, but more often a few rooms 
on the ground-floor of the hospital are used. Usually a clinic is 
held daily. The attendance is in most places very large. A hospital 
run by a single doctor will often have a daily clinic averaging from 
fifty to a hundred or more patients. The larger hospitals may have 
over two hundred daily. The size of the clinic and the understafiing 
of the hospital give rise to the one great criticism that can be applied 
to this work. It is necessarily carried on so quickly and the out- 
patients are passed along so rapidly that careful work is quite 
impossible. This is more true of medical cases than of surgical 
cases. The latter are more obvious and the treatment more definitely 
indicated. Medical cases often require time for definite diagnosis, 
and time is one of the things that the doctor does not have, so he is 
forced to take a hasty look, guess, and trust that he is prescribing 
correctly. It is frequently said of the Chinese that they appreciate 




WARD AT THE CHURCH MISSIONARY SOCIETY HOSPITAL, FOOCHOW 
Iron beds with springs or wooden slats covered by a straw matting. Very little bedding 

is needed in summer 




WARD AT THE XEW CANADIAN PRESBYTERIAN HOSPITAL. 
CHANGTEFU 

Patients supply their own clothes and bedding 



Western Medicine in China 65 

western surgery, but that for internal diseases they prefer Chinese 
medicine. This fact is borne out by hospital statistics, but one 
reason for it, at least, is readily explained. They have been given 
the best of western surgery, but they have seen Uttle of first-class 
western medicine. The Chinese is shrewd enough to distrust a 
hasty, cursory observation of his case, and he will probably be wise 
enough to recognize the difference when his internal diseases receive 
the careful study that is due them. In at least one hospital 
where a small number of out-patients are seen daily and where 
time is taken for proper examination, the work of the medical and 
surgical clinics has been greatly benefited. 

The usual custom is for the foreign doctor to see all the patients, 
or at least all the new ones. The ordinary dressings are done by the 
Chinese assistants, and the prescriptions are filled by Chinese 
assistants trained in pharmacy. Minor operations are performed in 
the dispensary by the doctor after he finishes seeing the patients. 
The out-patients are usually supposed to pay a few coppers at 
their first visit and one or two coppers at subsequent visits. An 
arrangement is sometimes made by which out-patients can see 
the doctor out of hours, or at special hours, on the payment of a 
higher fee. 

The out-patients arrive at the waiting-room some time before 
the hour for the beginning of the clinic, and advantage is taken of 
this fact to give the hospital evangelist an opportunity to preach to 
them. In some places the evangelist preaches for half an hour 
before the clinic opens, and in others he continues talking to them 
in the waiting-room until it closes. 

THE HOSPITAL STAFF 

1. Foreign Doctors. — As in any large group of men, one finds 
almost every type among the medical missionaries in China. On 
the whole the standard both of medical and of general efl&ciency 
is high, and not a few would have made their mark professionally 
anywhere in the world. The day of the half-trained medical mis- 
sionary is rapidly drawing to a close. The fact that even now a 
certain number of insufficiently equipped men find their way to the 
field seems to be chiefly due to the methods of selection adopted by 



66 China Medical Commission 

some of the mission boards. In the appointment of medical mis- 
sionaries they should be guided by the advice of medical men who are 
in a position to pass properly on a candidate's qualifications. In 
some missions this is apparently not customary, and the result is 
that men who have not had the requisite professional training, 
or whose personality is not adapted to the work, are sent to China. 
Some of these return home after a short trial, and others remain to 
carry on comparatively ineffective work. In either case there is 
an economic loss from every point of view. As a matter of fact 
the nature of medical work in China is such that only men of the 
strongest personalities and of the highest professional training are 
of value. The man who goes to China needs a much broader train- 
ing than his brother who remains at home, for he is called to face 
every conceivable kind of medical work, and usually he must meet 
it without consultation. Two years of hospital work, after finishing 
the medical course, should be the minimum requirement and it is of 
great advantage to have some additional special training. It is 
unwise policy to select a missionary doctor on the ground that he is 
a good evangelist. Almost every strong medical man in the field 
knows that his influence in helping the work of Christianity depends 
primarily on his effectiveness in carrying out his own job. 

The missionary doctor is invariably overworked. This is not 
merely due to the pressure of the strictly professional demands, 
which are heavy enough to exhaust the energy of any one person, 
but to the innumerable other duties that fall to his lot. In addition 
to the care of his patients and to operating, the doctor has the general 
management of the hospital involving a considerable amount of 
financial business. Besides this he usually has teaching, for he must 
at least train his own assistants. Then he must always be a some- 
what experienced builder and architect, for whatever building is 
done must be superintended by him personally. To this is added 
evangelistic work if there is any time left. Frequently there is not, 
however, and the doctor leaves this branch to the hospital evangelist. 
On top of all these duties comes the fact that the doctor seems to be 
regarded as the " handy-man-about-the-house " of the mission, and 
he is consulted with, or asked to attend to a mass of other matters 
which have no relation to medicine, but which require the wise, 




LEPER HOSPITAL, SL\OKAN 
Chapel and wards. This shows the possibihty of orderliness in (Miina 




LEPER HOSPITAL, SIAOKAN 
Entrance 



Western Medicine in China 67 

common-sense attention of someone who can be depended on as 
being on the spot continuously. It is a remarkable fact that in 
spite of all, many of the men make time for reading and study, and 
not a few are in touch with the latest advances in the fields in which 
they are interested. Such are some of the duties that are put on the 
missionary doctor, and in connection with this one is brought face to 
face with the most immediate problem which confronts the mission 
hospitals. It is practically true that every mission hospital is 
terribly understaffed.^ A large proportion of hospitals have but one 
doctor. Those that have tw^o doctors have usually increased their 
work so that they are little better off. Outside of the largest cities 
there are scarcely any hospitals with more than two men. One 
cannot but recognize with admiration the remarkable manner in 
which many men are able to carry on a large hospital work, wath 
perhaps a hundred in-patients and a large daily dispensary, single 
handed. They are men of forceful personality, of marked executive 
ability, able and eager to cope with any situation. But they are 
overdriven, and their work is necessarily productive of less good 
results than it would be if they had proper assistance. Moreover 
even the strongest must stop sometimes, and this means that the 
hospital must close for vacation, usually during the summer, when 
the need of it is great. 

The problem of properly staffing the mission hospitals is a difficult 
one. One is sometimes told that the trouble is lack of money, and 
sometimes that it is lack of men. Probably it is both. Some of the 
American missions have the salary for a doctor, but are unable 
to find a suitable man, while others cannot raise the money. There 
is some evidence to show that it may be easier to find men in England 
than in America, but the new Insurance Act has given so many 
opportunities for medical men in England that a smaller number are 

1 Of fifty-five mission hospitals investigated only eleven had more than two 
foreign doctors. Nine of these are teaching hospitals in Peking, Canton, Foo- 
chow, Nanking, and Shanghai. One is connected with the Women's Medical 
College in Soochow and one is at Hangchow where an enormous work is carried 
on. Of the remaining forty-four hospitals, twentj'-five have one foreign doctor, 
seventeen have two, and two have temporarily no foreign doctor. Twenty of 
the hospitals have no foreign nurse, and only seven (including one Cathohc Hos- 
pital) have more than one nurse. 



68 China Medical Commission 

looking to the foreign field. It is possible that some increase in 
salary might bring more men. While the missionary doctor is not 
primarily interested in the financial aspect of his career, the salaries 
are for the most part very low now, and regard for the care of his 
wife and family might well make one hesitate before taking up the 
work.^ One means which might help would be the bringing out of 
men for short terms of two or three years. This would give the 
man a chance to see China and to find out on the spot whether he 
was interested in it and whether he wanted to stay in mission work. 
Some of the men in the field would welcome such assistance, but 
others feel very doubtful about it. They think that unless a man 
comes prepared to give his life to China with the "missionary 
spirit," he might be unsympathetic with the work and would hinder 
rather than help. It also takes a good deal of the "missionary 
spirit" to make a man stand by his work in spite of all the set-backs, 
disappointments, and difficulties that he is sure to be brought to 
face. It must be recognized that, in spite of being overworked, many 
men who have built up their own clinic rather dread the coming of 
a new man who may bring new ideas and interfere with the running 
of things. And unfortunately certain experiences tend to show that 
great care must be exercised in trying to give help of this sort. The 
problem of understaffing can probably never be solved by the pro- 
vision of foreign doctors, even if it were a wholly wise policy. The 
most promising and obvious solution lies in the training of high 
grade Chinese doctors. 

2. Chinese Doctors and Assistants. — There are at present very 
few Chinese medical men who have been trained in Europe or 
America, and only a small proportion of these are connected with 
mission hospitals. A larger number have studied in Japan, but 
most of them attended second-rate schools, and they have either 
gone into private practice or government service. The assistants 
in the mission hospitals have almost all been trained by the mission- 
aries. A few of them are graduates of the newer union schools but 
the majority are the product of the hospitals or hospital schools. 

^ The average salaries for married men range from $1,000 to $2,000 (gold) 
in addition to quarters. This is a living wage, but it means the most rigid 
economy. In some missions the salaries are even lower. 



Western Medicine in China 69 

Every missionary needed, of course, assistants and the only way 
to get them was to train them himself. The usual custom has been 
to take a few boys into the hospital and train them as dressers. 
After some years they often become useful assistants, doing most 
of the nursing, dressings, and even a certain amount of minor surgery. 
The more experienced are skilful men, and invaluable as long as 
they are under supervision. Some of the missionaries have done 
this training on a larger scale, giving more or less systematic courses 
of instruction on the subjects usually contained in the medical 
curriculum, while the students are simultaneously working as 
clinical assistants in the hospital. On this basis there have developed 
several miniature medical schools with one, two or more rarely 
three, instructors. The usual requirements for admission are an 
ability to read and write Chinese, with perhaps some knowledge of 
arithmetic. At the end of five or six years a diploma is given. Those 
who finish the course have had much practical experience on top of a 
rather flimsy preparatory training. They are often very useful 
men as assistants and some of them are fitted to do work of a certain 
grade independently. Thus there is much minor surgery that they 
can handle successfully — as w^ell and perhaps better than an experi- 
enced orderly in an American hospital. The great difficulty is that 
there is no means of controlling the type of work they will do, and 
that they are almost sure to deteriorate as soon as they leave the 
hospital. Some of the graduates continue in the service of the 
hospitals at which they have studied, or in other mission hospitals, in 
part for the living they get out of it, and in part on account of their 
interest in missionary work. Exceptional men have made good 
records in temporary charge of mission hospitals. The mission 
hospitals, however, are able to pay only very moderate salaries^ so 
that a large proportion of the men seek other employment. Indeed 
with the comparatively great financial rewards which may be looked 
for in private practice, in railway or in government work, it is fre- 
quently very difficult for the hospitals to keep sufficient assistants 

1 At Swatow $12 to $15 (Mex.), at Paotingfu $28 to $34 (Mex.), one Shanghai 
hospital, $40 (Mex.) a month. Another Shanghai hospital pays two men $50 
and $100 (Mex.). The latter is unusually high but the man is said to be 
exceptional. The railways pay from $150 to $200 (Mex.) per month. 



70 China Medical Commission 

to carry on the work properly. There are so few Chinese medical 
men at the present time, and so many positions waiting for them, 
that men with the most meager training may obtain posts of con- 
siderable responsibility to which large salaries are attached. The 
graduates of these hospital schools have not been trained to a 
high enough professional standard to make them realize the advan- 
tages to be gained in the end by constant contact with a foreign 
hospital. 

This system of training hospital assistants has been a necessary 
step in a country where there is no other means of obtaining help. 
It is useful in so far as it fills the immediate needs of the hospital 
doctors. Its value in providing independent practitioners through- 
out the country is however very questionable. In India the training 
of low grade men has been tried, but it has recently been discon- 
tinued and no new candidates without the degree of M.B. will be 
admitted to practice. Moreover, the training of assistants puts a 
heavy burden on the foreign doctors — a burden of which the majority 
are anxious to be reheved. The establishment of high grade medical 
schools in China should soon make unnecessary the teaching of 
low grade men. The hospitals and the schools will work hand-in- 
hand — the hospitals supplementing the schools by giving practical 
interne experience to men who have already had sound preliminary 
teaching. Many of these graduates should subsequently become 
permanent paid assistants, at good salaries, at the mission hospitals. 
Those who are qualified may also be put in charge of branch hospitals. 
Many who do not desire to do hospital work exclusively may go 
into private practice, and continue to devote a part of their time to a 
hospital in return for a fair compensation. As many as possible of 
the graduates of the medical schools must certainly be kept in more 
or less intimate contact with hospitals under foreign control. This 
is a cardinal principle, for experience has shown not only in China 
but in Japan, and in India, and in the Philippines that the western 
influence and control are essential to prevent deterioration of pro- 
fessional standards. 

3. Nurses. — No one can visit hospitals in China without coming 
away profoundly impressed with the need for more foreign nurses. 
The influence of the nurse shows itself everywhere in the appear- 




OPERATING-ROOM AT THE NEW LONDON MISSIONARY SOCIETY 

HOSPITAL, PEKING 

Dr. Thacker operating, assisted by fifth-year students 



Western Medicine in China 71 

ance and efficiency of the hospital, and, by relieving the doctor of 
innumerable responsibilities she promotes directly his own immedi- 
ate work. Moreover in much of the educational work of the hospital 
— in the teaching of cleanliness and hygiene — the nurse is a more 
important factor than the doctor, for she is directly responsible for 
the standards and example set before the patients. In the care of 
women patients and especially in obstetrical work the presence of a 
nurse is most helpful, and with her assistance a male physician can 
do almost as much as a woman physician. Perhaps the most 
important function of the nurse, next to general supervision of the 
wards, is the training of pupils. In several hospitals training 
schools for both male and female nurses have been established along 
lines analogous to those in the best American and European hospitals. 
In others nurses are being given more elementary training. It is 
sometimes said that a woman cannot administer the male wards 
or teach the male nurses, but the experience of various institutions 
proves the fallacy of this statement. 

The training of nurses along western lines is a comparatively 
new movement in China, but it has already acquired considerable 
impetus in certain parts, and more especially in central China.^ 

In southern China there are few nursing schools, and it is said 
to be hard to get proper persons to take up the profession. The 
hospitals in the Yangtze Valley are better supplied with foreign 
nurses than are those in other regions, except perhaps Fukien. The 
cause of nursing has been greatly aided by the formation of the 
Nurses' Association of China, which has established regulations 
governing the course of training and study which must be complied 
with by schools desiring to be recognized by the Association. It 
holds annual examinations for such graduates of these training 
schools as wish to obtain the Association diploma. A prize, given 

1 Thus in the Men's Hospital of the American Church Mission at Wuchang 
with two foreign nurses, there are sixteen male students. At the American 
Church Mission Hospital at Anking with two foreign nurses, there are twelve 
male and nine female pupils. In the Friends' Hospital at Nanking there are 
fourteen pupil nurses. At Kiukiang in the Methodist Episcopal Hospital there 
are twenty yoimg women iia training. There are already eighty graduates of 
this school. In the Methodist Episcopal Hospital for Women at Nanchang 
there are twenty pupil nurses. 



72 China Medical Commission 

annually to the nurse passing the highest examination, is a further 
stimulus to good work. On account of social conditions in China it 
is necessary at present to have male nurses for male patients. The 
time will come, however, when women can do all the nursing. In 
some places it will come very soon, but the general tendency, and no 
doubt the wisest, is not to hurry too much so radical a change in 
custom. The problem is not serious, for it is comparatively easy to 
get fairly competent young men to enter the training schools, and 
they seem to turn out efficient nurses. The work in training girls 
has been even more satisfactory, and those engaged in it are 
encouraged by their experience to believe that Chinese women may 
be made into excellent nurses. Emerging suddenly from generations 
of ignorance they are naturally lacking in self-confidence and in 
reliability, but the course of training produces remarkable results. 
As yet the requirements for admission are necessarily low. In 
some cases only a knowledge of how to read Chinese and how to 
write a limited number of Chinese characters is demanded, but in 
others graduation from an intermediate school or other equivalent 
education is required. Many of the girls, however, are much better 
educated and there is a general tendency to raise the standards as 
fast as possible. The higher the standard is raised the better 
will be the class of girls entering the training schools and the sooner 
will the nursing profession cease to be regarded as "coolie labor." 
Already one hears not infrequently of girls of the better classes 
taking up the work. The course in the better schools usually 
lasts three years and is essentially the same as in the western 
training schools. Translations of English textbooks are used. 
Obstetrics forms an important part of the nurse's training, as the 
native midwives are so ignorant as to be a real source of danger 
to the community. The Nurses' Association requires for their 
special diploma in midwifery one year's training in addition to 
the three years of training for the nurse's diploma, and the passing 
of written, oral, and practical examinations. There are a number of 
graduates of those nursing schools doing private work and their 
reputation, even among foreigners, is excellent. Many of the grad- 
uates, of course, marry immediately, but their training must be 




STERILIZlMi-UOO.M AT THE SOUTHERN METHODIST EPISCOPAL 
HOSPITAL, KASHING 



Western Medicine in China 73 

an important influence in their own homes and in the homes of 
others. In Changsha there is even a Chinese district nurse who is 
demonstrating the possibility of improving domestic conditions 
along a line which is new in China, and one believed by many to be 
as yet impossible. 

The need of more graduate nurses in China is of course imperative. 
At present there are 140 foreign nurses in the country and these are 
distributed in about 100 hospitals. Thus less than one hospital 
in two has a graduate nurse at all and few have more than one. 
It does not seem easy to get nurses, but in some instances the 
missions are hampered by lack of funds. It is possible that the 
situation might be helped if nurses could come out to the hospitals 
as nurses and not necessarily as members of the missions. While 
some doctors would oppose this arrangement others would certainly 
welcome it, and be glad of any help. Even after getting nurses out 
to China the difficulties are not over. For the first two years a 
considerable part of their time must be taken by language-study — 
and at the end of that time a good proportion get married. With 
proper funds it may be possible to supply enough foreign nurses to 
serve as teachers in the leading training schools, but the other 
hospitals will have to depend for the most part on the Chinese 
graduates of these schools. The situation will be helped if it is 
possible to provide even a limited number of Chinese nurses who 
have had post-graduate nursing in America and are able to bring 
back the best that the profession has to offer and to undertake the 
training of others. 

In the hospitals without foreign nurses the care of the patients 
is much less adequate. In several women's hospitals the woman 
physician in charge has undertaken the training of nurses and so gets 
a class of probationers who can do the work of the institution. In 
one at least there is an excellent training school. In some of the 
men's hospitals there are similar classes for male nurses who receive 
some instruction from the doctor. In other hospitals the nursing 
for men is done in part by half-trained coolies, and for women by 
"amahs," while the bulk of the care must be taken by the patients' 
friends and relations. 



74 China Medical Commission 

THE PATIENTS 

In the early days of medical missionary work in China there was 
a feeling of distrust and often of hostility on the part of the people 
toward the newcomers. Stories were spread abroad of patients being 
cut up, of eyes being taken out to be made into medicine, and of 
other similar atrocities, all of which tended to keep people from 
coming to the hospital. Even after the work became fairly well 
established the doctors were not safe in performing any operation 
which might end fatally, and to have a patient die in the hospital was 
a serious matter. And now, when medical work is first started in a 
new city, the conservatism and opposition of the populace must be 
overcome. But in the centers where hospitals have been carried 
on for several years, the patient, wise, and tactful methods of the 
doctors have been rewarded. The confidence of a large part of the 
people has been given to them; patients flock to them in large 
numbers and their reputations have spread through miles and miles 
of country round. There are now scarcelj' any hospitals that do 
not have all the patients they can attend to, and the majority of 
hospitals have many more than they can care for properly. Patients 
are no longer refused because they are likely to die, and serious 
operations are performed in which the patient and his family realize 
that it is a matter of life or death. 

The patients in the mission hospitals come from all classes of 
society. The great majority belong, of course, to the poorer ranks, 
but the more prosperous people also come in considerable numbers. 
Thus there is usually quite a demand for private rooms. Those 
doctors who have made a point of cultivating an intimate rela- 
tionship with the upper classes of Chinese often number members 
of the official class among their hospital patients. Many more of 
the upper classes are apt to be seen by the physician as patients 
in their own homes. The extent to which practice in the patients' 
homes has been cultivated varies with the personal inclination of the 
doctor. Some men desire this outside practice as it brings them 
in contact with influential people and forms a considerable source 
of income for the hospital. Others discourage it as it takes them 
away from their hospital work for so long a time. Moreover, prac- 




DR. MARY STOXE AND HER TRAINING-SCHOOL FOR NrRSI> 

KIUKIANG 




MEDICAL STAFF, WITH MALE AND FEMALE NURSES, KASHING 



Western Medicine in China 75 

tice in the Chinese homes is apt to be very unsatisfactory. There 
is no assurance that one's directions will be carried out, and it 
quite often happens that one or two Chinese practitioners of the old 
school may be coming to the case at the same time. The Chinese 
custom is to keep calling in new doctors until one of them gives a 
medicine which is followed by an amelioration of symptoms. The 
last man is then credited with the cure, regardless of what the 
natural history of the disease may be. 

The practice of the mission hospital is by no means limited to the 
city in which it stands. It draws on a large country round and it is 
not unusual to have patients brought from a distance of twenty- 
five or even fifty miles. Boats, carts, donkeys, wheelbarrows, and 
stretchers of the most primitive kinds are used for transportation 
purposes. Many of the patients are not seriously sick and if they 
had good homes near by they could be treated as out-patients, but 
coming so far they must be taken into the hospital. Similarly other 
patients who live near by are taken in as their home conditions are 
so miserable. Thus it is that one sees a much larger proportion of 
ambulatory cases in the hospitals in China than in those of the west. 

While the people of China are becoming more and more friendly 
to western medicine it must not be supposed that the native prac- 
titioners are by any means deserted. In general people regard west- 
ern surgery highly, but they have less respect for western medicine. 
In one of the Chinese hospitals in Peking the patients are given their 
choice of going to a practitioner of native or of western medicine. A 
large number choose the native medicine — and in truth when one 
compares the wise, dignified, scholarly-appearing native doctors with 
the young exponents of w^estern medicine, one has much sympathy 
with their opinion. At the Tung Hua Hospital in Hongkong a 
similar choice is given, but all the patients are seen first by a doctor 
of western medicine and urged to come under his care. Nevertheless 
60 per cent decide to go to the native practitioners. Almost all 
the foreign physicians have been interested primarily in surgery, and 
lack of time has not allowed them to devote the proper attention to 
their medical cases, but in those clinics in which internal medicine 
has been developed independently the number of medical cases is 
not far behind that of surgical cases. 



76 China Medical Commission 

The types of diseases met with in the hospitals of China vary- 
greatly in the different parts. Tuberculosis and syphilis are every- 
where rampant. The amount of tuberculosis of the bones is espe- 
cially striking. In North China the general run of cases in the 
wards is not very different from what one finds in a similar climate 
in the west. In North and North Central China Kala Azar is 
fairly common. In Central China the diseases caused by intestinal 
parasites are the most characteristic cases, and in -summer the 
dysenteries and cholera. Along the coast, in Fukien Province, 
there is an interesting focus of filarial infection. From Central 
China southward beri-beri is common. Approaching South China, 
the amount of strictly tropical disease increases — for example, 
beri-beri is common; bubonic plague appears regularly in the early 
summer; cholera and dysenteries are very frequent. In the 
neighborhood of Canton there is an immense amount of stone of 
the bladder. In 1913 seventy-one operations for lithotomy were 
performed at the Canton Hospital. The cause of the remarkable 
occurrence of stone of the bladder in this district has not yet been 
determined. 

The amount of obstetrical work done in the hospitals is increas- 
ing rapidly. The Chinese women have always been reluctant to 
have a male physician attend them when they are confined, so for a 
long time obstetrical work was practically in the hands of the few 
women physicians, and even at present they control most of the 
largest obstetrical clinics. There are, however, many men who are 
getting a considerable and an annually increasing number of cases. 
Frequently the women do not want to come to the hospital for 
confinement so they are cared for in their own homes. In some of the 
hospitals much of the obstetrics is handled by the more experienced 
of the Chinese nurses. They are able to take complete charge of the 
normal cases, and only summon the doctor when abnormal con- 
ditions arise. Foreign nurses have been of great assistance in the 
obstetrical work of hospitals which are controlled by male physicians. 
The experience of one women's hospital in Central China with 
regard to obstetrics is of considerable interest. This hospital has 
over two hundred cases a year, coming from both rich and poor 
families. The great majority are handled in the patients' homes by 




OUT-PATIENTS WAITING IN THE COURT AT THE (iOVERXMENT 
HOSPITAL, PEKINCf 



Western Medicine in China 77 

the nurses. Usually two nurses, one older and experienced, and one 
younger pupil go together. If the case proves to be abnormal the 
doctor is usually sent for, but one of the Chinese graduate nurses is 
able to put on forceps. The obstetrical fee is from $3 to $6 (Mex.). 
In the summer vacation the work is superintended by a male physi- 
cian, but there is no noticeable decrease in the number of patients. 
He is an older man who is well known in the community and is 
regarded with great confidence. This merely serves to illustrate the 
type of work which can be developed, and the enormous humani- 
tarian importance of it can only be appreciated by one who knows 
of the immense amount of unnecessary suffering and death which 
mark the trail of the native midwife. 

There is as yet a comparatively small amount of abdominal 
surgery in China. Appendicitis is remarkably unusual, and acute 
and chronic salpingitis are not common. It seems probable, how- 
ever, that when more careful medical examinations are made the 
number of cases in need of gastric and intestinal surgery will be 
found to be considerable. It might almost be said that as yet 
the field of abdominal surgery has hardly been entered upon. 
Everyone has been busy with more simple and more obvious 
work. 

FINANCES 

It is a rather remarkable fact that a large proportion of the mis- 
sion hospitals are, with the exception of the doctor's salary, self- 
supporting or nearly self-supporting. The missions usually contribute 
the salary of the foreign doctor, and of foreign nurses, if there are 
any. Beyond this they sometimes contribute a small sum — a few 
hundred dollars — to the support of the hospitals. A few hospitals 
receive larger grants from their Home Boards, but probably more 
receive nothing beyond the doctors' and nurses' salaries. All other 
support must come from the field, and it is derived from the earnings 
of the hospital and from gifts. 

The majority of the patients go into the open wards and pay 
from ten to fifteen cents a day (Mex.) which just about covers their 
"rice." Many patients, of course, cannot afford even this and are 
accepted as charity patients. A considerable number of patients go 



78 China Medical Commission 

into second and first class rooms and pay from fifty cents to about ! 
$2.00 (Mex.) a day. These patients are a true source of income to 
the hospital. Occasionally there are special fees for operations or for 
maternity cases. The fees received in the out-patient department 
make some additional income. Patients usually pay about three to 
ten cents (Mex.) at the first visit and from one to five coppers at sub- 
sequent visits. They are also supposed to pay for the bottle for their 
medicine, but there are many who cannot pay the regular fee, and 
must be given their medicine. Many hospitals have an arrangement 
by which the better class of patients are put in a separate waiting 
room and see the doctor first, paying twenty cents for the privilege. 
It is also customary to charge from twenty cents to SI. 00 (Mex.) 
for consulting the doctor out of regular hours. At one hospital 
the senior physician has a special out-patient clinic at which 
patients pay $1.00 a visit. A large source of income is frequently 
out-patient practice in the patients' homes. The advantages and 
disadvantages of this have been mentioned. For outside calls the 
doctor gets from $2.00 to $5.00 (Mex.) A certain number of 
hospitals receive a considerable income from contract practice for 
the foreign firms, the customs service and the post office service. 
Small sums may be realized for the care of the members of other 
missions. 

Among the donations to the hospitals may be mentioned those 
obtained from home by personal solicitation of the doctor or his 
friends (usually for special purposes), those raised among the for- 
eign community, especially in the open ports, and those coming 
from the Chinese. The latter are often a very important item. At 
one place $3,700.00 (Mex.) have been donated since the hospital was 
opened about ten years ago. The gifts vary greatly in different 
places and depend in large part on how long the work has been estab- 
lished and on the personality of the doctor. Some men become close 
friends with the local gentry and officials, and are able to get very 
considerable support from them. In many instances they have con- 
tributed liberally to the construction of new buildings, or to some 
similar definite object. It is natural that other hospitals situated 
in less prosperous communities can rely but little on local contribu- 
tions. 




A PATIENT BEING CARRIED IN FROM THE COUNTRY TO DR. STONES 
HOSPITAL. KIlKIANfi^ 




AT THE GATE OF THE CHINA INLAND MISSION HOSPITAL, KAIFENG 
The patients are brought in on wheelbarrows 



Western Medicine in China 79 

The following is the financial statement of one hospital in South 
China conducted by a man of unusual ability, whose only foreign 
assistant is his wife, who has studied nursing. The hospital had in 
1913, 1,232 in-patients, 2,833 out-patients; 187 patients were seen 
in their homes, and 140 on itineration. Total operations, 547, 
opium smokers treated, 167, 

Income Expenditures 

Chinese fees and donations £350 Chinese assistant, salary £ 40 

Fees from schools (mission) .... 10 Wages 65 

Foreign donations, including 9 Drugs and dressings 160 

supported beds — £ 3 each ... 80 Instruments and upkeep 30 

Sales, bottles, soap, etc 60 Buildings and repairs 60 

Income from kitchen account. Fire and light 60 

sale of pigs, fruit, excreta, etc. 50 Poor 20 

Customs and carriage 60 

Sundries, stationery, etc 55 



£550 £550 

The salary of the foreign doctor, £320, is not included. It is 
the only financial contribution from the Mission. 

NON-MISSIONARY HOSPITALS UNDER FOREIGN CONTROL 

The hospitals under the control of foreign non-missionary bodies 
are few in number. Some of them (the Do-Jin Hospital in Peking 
and the H6pital Doumer of the French Government in Canton) are 
for the Chinese, but the more important like the Shanghai General 
Hospital and the International Hospital at Hankow are for the 
exclusive use of the foreign community. As yet, however, the 
medical care of foreigners in China is very inadequately provided 
for. This is true in cities like Peking and Tientsin, with large 
foreign communities, but is more true when considering the great 
body of foreigners, mostly missionaries, scattered throughout- the 
country. There are few places for them to resort to when they are 
sick, and the majority of them return to their homes for diagnosis 
and treatment that should properly be obtainable in China. With 
this in view a small hospital has been constructed at Nanking, 



80 China Medical Commission 

which has as its chief aim the care of sick missionaries, but which 
also takes in any other foreigners. It would be much better, how- 
ever, to have a foreign ward as a part of a large thoroughly 
equipped modern hospital. Thus in the construction of any new 
hospitals in the large centers the care of foreigners should be borne in 
mind, and adequate provision should be made for them to obtain the 
best that modern medicine can provide at a limited expense. 



IV 

STANDARDS OF MEDICAL EDUCATION UNDER 

MISSIONARY AUSPICES. TEACHING IN 

CHINESE OR IN ENGLISH 

There are two policies propounded for the training of Chinese 
as medical men. 

One of these looks first of all at the pressing need, and seeks to 
meet that need at the earliest moment and to the largest practicable 
extent. This involves taking students who are not educated very 
far and giving them a hasty and more or less superficial training. It 
involves at the present teaching in Chinese and depending on books 

translated into that language from English or German sources. -- 

— J 

This policy is not justified by its fruits. It does not fill the need 
for trained physicians because it does not really train physicians. 
The graduates are useful as hospital assistants, but are not fitted for 
the responsibility of medical practitioners. 

The other policy contemplates preparing a smaller number of 
graduates, but doing work only of a high grade. The use of English 
is imperative for instruction of this character, and to enable students 
to have access to medical literature. There must be in order to carry 
out this plan an adequate preliminary training. This is the policy 
favored by the majority of the most enlightened and progressive 
medical men and teachers in the missionary schools, by similar men ; 
in Shanghai, Canton, and Changsha, and by all the Chinese medical^ 
men of high standing with whom we have talked. It is considered 
practicable, because now there are enough middle schools and 
missionary high schools for preparatory work, and because more 
Chinese young men of good qualities will be drawn by work of a 
high scientific value. Doubtless it will be necessary to provide in a 
strong medical school two years of pre-medical education. 

The General Secretary of the Educational Association of China 
has prepared a list of Chinese Government Middle Schools, which 
is as nearly accurate as practicable at the present time, in which 

81 



82 China Medical Commission 

four hundred thirty-eight middle schools are reported. In all these 
English and modern sciences are taught. 

While the efficiency of the government schools is not yet uniformly 
of a high order, still it is likely that they will gradually improve, and 
there should be enough of their graduates, carefully selected, to enter 
the pre-medical work of the medical schools. By the end of the two 
pre-medical years the students should have enough science and 
English to do work of a high order. The missionary high schools 
also are capable of furnishing a considerable number of properly 
prepared students. 

It will be seen that a vital question connected with the subject 
of standards for medical education in China is that of the language 
which shall be the medium of instruction. 

On the one side it is held that teaching should be wholly in 
Chinese and that there should be conducted a very active industry 
in the translation of the best works of modern medical science into 
the Chinese language for the use of students and physicians. The 
adherents of this belief maintain: (1) that the use of the vernacular 
enables the Chinese student to take up a medical course without 
the previous great labor of acquiring a foreign tongue; (2) that it 
is better to expect the teacher to spend three years in learning 
Chinese which he can then use for the rest of his teaching life than 
to require succeeding generations of Chinese students to spend each 
of them from four to six years acquiring English, for instance, before 
being able to enter medical work; (3) that after a student learns his 
medical science in a foreign language he becomes so far diverted from 
the practical use of Chinese that he finds difficulty in the application 
of his western science and especial difficulty in making his examina- 
tion of patients; (4) that they expect and wish that the medical 
profession in China should become as quickly as possible a real 
Chinese profession, and that it should not be made up of men who 
have been alienated from their own people and rendered deficient in 
Chinese culture through education in a foreign language; (5) that 
young men who know sufficient English to study medicine in that 
language command at once such high salaries in business and other 
pursuits that few of them will take the additional time necessary 
to give themselves a thorough medical education. 



Standards of Medical Education 83 

Further it is held that the need for native practitioners is so 
great, so immediate, and so pressing on all sides that everything 
should be done to facilitate the teaching of students as rapidly as 
possible, so that there can be a considerable body of practitioners at 
the earliest possible date provided with such knowledge as it may be 
practicable to give them even in a limited time. 

These views are strenuously held, e.g., by a majority of the 
Faculty of the Union Medical College in Peking (the last vote of 
the Faculty was eight in favor of the use of Chinese and seven in 
favor of the use of English) and by the Faculties of the Union 
Medical Schools at Tsinanfu and at Hankow. 

The other view is that medical teaching should be wholly or 
mainly in a western language and that that should presumably be 
English. In favor of this view it is held: (1) that it is entirely pos- 
sible for students in the middle schools to acquire sufficient English 
to use in medical work; (2) that there is no great body of medical 
publications in China and for a long time to come there is likely to be 
nothing in Chinese except a few translations which by the nature of 
the case will be more or less behind the times, while by the use of 
English students will have the whole wdde field of the new medical 
science open to them; (3) that the use of English greatly widens 
the field for the choice of medical teachers by preventing the very 
onerous burden of learning Chinese being placed on every teacher in 
a medical school; that it would probably be impossible to find any 
considerable number of well-qualified professors who would be willing 
to devote two or three years to a study of the Chinese language, and 
thereafter to spend a large part of the time for preparing lectures in 
the laborious task of putting them into good Chinese; (4) that a 
graduate in medicine should no longer be debarred from keeping up 
with the advance of medical science because there is not open to him 
the great field of medical literature both in books and scientific 
periodicals in which the English language is rich. It is not likely 
for a long time to come that the Chinese language will contain any 
such body of literature. 

This view of the case is held very strongly, e.g., by the minority 
of the Faculty of the Union Medical College at Peking, by the Fac- 
ulty of the proposed Yale Medical School at Changsha, by the 



84 China Medical Commission 

St. John's and Harvard schools in Shanghai, by the Faculty of the 
Canton Christian College for the proposed school at Canton, and by 
the Faculty of the Union Medical College at Foochow. It may be 
added that a similar view is taken by the Germans who are con- 
ducting medical work at Tsingtau and Shanghai with the substitu- 
tion of German for English, naturally by the English in their 
medical school in connection with Hongkong University, and even 
by Chinese in the Peiyang Medical College at Tientsin, a govern- 
ment institution. Practically all the western trained Chinese physi- 
cians with whom we have talked share this view, as do many 
influential Chinese educators. They say that neither the termi- 
nology of the missionaries nor that of the Japanese is satisfactory, 
and that on the whole the English textbooks are easier for the 
students to understand than the Chinese translations. The best 
students ask for instruction in English. 

In this connection it may be interesting to note the Japanese 
experience in dealing with the same problem. All Japanese students 
in the University medical schools have had five years of English in 
the secondary course and three years of German in their college 
course. Those who enter the second grade medical schools directly 
from the middle schools have special instruction in the German 
language for the four years of their medical course, side by side with 
their medical studies. Medical school teaching is mainly in Japanese, 
but students and professors freely read the other languages and have 
textbooks in all three. Of course there now exists a considerable 
body of Japanese scientific literature both in books and in periodi- 
cals. Japanese medical instruction began in German and even now 
a great deal of German is used by the Japanese professors in lecturing 
to their students. In the Kyoto and Tokyo University Hospitals 
and in the prefectural hospital at Kyoto records of cases are kept 
largely in German. 

The first view, that of instruction exclusively in Chinese, is held 
by those who are eager to meet the present needs of China in the 
shortest possible time and who are willing to make the standards of 
medical training quite low in order to secure a considerable number 
of medical graduates. The second is the view of those who believe 
that the crying need of China is not so much for a large number of 



Standards of Medical Education 85 

ill-trained men, but for a number, presumably small at first, of 
thoroughly trained medical men who will be able to man the medical 
faculties, hospitals, and institutes of investigation, to aid the govern- 
ment in the work of sanitation, and ultimately to provide efficient 
practitioners throughout the land. It is the belief of those who 
favor teaching in a foreign language that this process will take a 
longer time than the other, but in the long run will secure the largest 
and best results. 



DISSECTION AND AUTOPSIES 

Ancestor worship, one of the important outgrowths of Confu- 
cianism, requires of its adherents a profound respect for the dead. 
A desecration of the human body, such as is supposed to be caused 
by dissection or post-mortem examination, has been from time im- 
memorial wholly impossible in China. For this reason the physi- 
cians of China have remained in absolute ignorance of anatomy and 
of physiology, and the science of medicine in China has scarcely 
developed since its conception. The generally accepted method of 
studying anatomy is to memorize the books which have been in- 
herited from the past — books in which the descriptions and the plates 
demonstrate that neither the author nor the author's teachers ever 
made an anatomical investigation which went more than skin-deep. 
It is said that when the Japanese, who had adopted Chinese medi- 
cine, first saw a Dutch anatomical book, they declared that the 
people in the West were made differently from those in the East. 
But they were open to conviction, and in spite of religious beliefs 
akin to those in China, dissection made its way into Japan, the 
first known dissection being performed there on March 4, 1771. 

There are few factors which have been so potent in obstructing 
the advance of western medicine in China as has been the impossibil- 
ity of making anatomical studies. Dissection is essential for even 
the elementary work of the medical student, while autopsies are 
necessary to teach the nature of disease processes, and they are of 
fundamental importance in many types of research. Certain pecul- 
iar diseases in China can never be thoroughly understood until 
many post-mortem examinations have been made. Up to the 
present time the number of dissections and autopsies that have been 
done in China is practically negligible. One hears very rarely of a 
foreign doctor who has performed an autopsy, or more likely a 
partial autopsy. These have always been done with the utmost 
secrecy, for if news of them got abroad, the public might become 
inflamed, and the doctor and his hospital be in grave danger. At 

86 



Dissection and Autopsies 87 

one government school we were told that dissections had been 
carried on — that moribund patients were brought to the hospital 
from the jail, and that after death their bodies were dissected. 
Outside inquiry revealed the fact that this has happened, but it is 
doubtful if it has happened frequently. At another school it was 
said that bodies had been dissected, but the number is very 
questionable. At Shanghai a limited number of bodies have been 
obtained for dissection at the Harvard Medical School, and about 
six autopsies have been performed in the school. Conditions are of 
course very favorable in Shanghai, where there is a large foreign 
concession and a foreign health officer. In Hongkong, in British 
territory, the situation is quite different. The medical school can 
obtain all the material it needs for dissection, and about two thou- 
sand autopsies are performed annually by order of the health 
authorities. Some of the students of the Kwong Hua Medical 
School in Canton come to Hongkong in the summer for a special 
course in anatomy. On November 13, 1913, the dissection of the 
body of a criminal was performed at the Kiangsu Provincial Medical 
School in Soochow. Permission was given by the Governor and the 
occasion was one of great formality. Some sixty-five persons were 
invited to attend and those present included the representative of 
the Governor, judges of the higher courts, many other officials, and 
both Chinese and foreign doctors. The day was considered such 
a memorable one that the guests and the subject were photo- 
graphed, and a descriptive pamphlet was published in which it was 
stated that this was the first dissection in China for four thousand 
years. 

Human dissection thus having been impossible in China, anatomy 
has necessarily been taught with the aid of plates, models, bones, 
occasional material from operations, and in a few places a limited 
amount of animal dissection. As pathology is taught it consists 
almost wholly of the study of microscopic sections brought from 
abroad. Surgical operations provide a small amount of material 
for both gross and microscopic study. 

Late in 1913 the outlook for the teaching of medicine in China 
was entirely changed by the publication of an official edict' which 

* A translation will be found in Appendix B 7. 



88 China Medical Commission 

gave permission for the dissection in the medical schools of the 
unclaimed bodies in the jails. It is now only necessary for the 
medical school to apply to the local officials for permission, and for 
the officials to issue the requisite order. It is fair to say, however, 
that in China these steps are much less simple than they appear 
and it will probably be a long time before public opposition is entirely 
overcome. However, not many weeks after the issuing of the edict 
the Union Medical College in Peking had made its application and 
had in due course received three bodies. The edict came suddenly 
and no arrangements had been prepared for the preservation of 
bodies, so that it was necessary for a time to refuse other bodies 
that were offered. But that is of minor importance. The chief 
thing is that the custom of "four thousand years" has been broken, 
and once broken, there is no reason to suppose that it will ever 
again block the path of scientific medicine in Peking. Away from 
the capital, the edict has not yet produced any definite results. 
At Hankow, Nanking, and Foochow no bodies had been applied 
for. This was, no doubt, partly due to the fact that they had 
no proper place of storage, and that the summer vacation was 
just beginning. On the other hand it is striking that few of the 
schools in central and southern China seemed to be making any 
special effort to prepare for dissection. They had not taken the 
question up with the officials, and they were apparently not 
hurrying to make even temporary provision for the reception of 
material. 

The question of autopsies has practically not been touched. 
One rarely finds a foreign physician who has ever even asked to do 
an autopsy. We heard, however, of one physician who, a short time 
after the edict was issued, requested permission to make a post- 
mortem examination of a child who died in his hospital. The 
parents knew him and gave permission without difficulty. 

For some reason this edict, which will revolutionize the teaching 
of medicine in China, appears to have provoked very little stir among 
the teachers. The general attitude seems to be that "it may be all 
right in Peking, but we have got to go very slowly here. " How far 
this is actually the case it is impossible for one not intimately con- 
nected with local conditions to know, but it would certainly seem 



Dissection and Autopsies 89 

that all who are interested — both Chinese and foreigners, physi- 
cians and laymen — should take the question up while it is fresh. 
"The Republic" in China signifies much more than a new form of 
government. It means too the sweeping aside of many ancient 
social customs, and its advent marks the brightest time for striking 
at the roots of superstition. 



VI 

THE ATTITUDE OF THE CHINESE TOWARD 
MODERN MEDICINE 

The members of the Commission met Chinese officials in every- 
place visited, including officers of the central government and offi- 
cials of the provinces and cities. In no one case was there found 
any expression of opposition to the introduction of western medical 
teaching and practice into China. In nearly every case there was 
found on the other hand warm approval of the introduction of such 
work, and in not a few cases willingness was expressed to aid as far 
as possible if such work were undertaken on an adequate scale. The 
members of the Commission are convinced that the introduction of 
medical teaching on a large scale and on a high standard would re- 
ceive the approval of the government and its moral support. Letters 
received by the Chairman of the Commission from the Minister of 
Education in Peking and from the Governor of Hunan Province 
at Changsha are especially interesting in this connection. (See 
Appendix B, 1 and 2.) 

The old prejudice against western medical men and their methods 
still remains undoubtedly in many parts of China. At the same 
time this prejudice is breaking down everywhere. The fact that 
the missionary hospitals are taxed beyond their capacity shows 
better than words the actual state of things in this regard. The 
willing support given missionary hospitals by native Chinese, many 
of whom are not Christians, is also an evidence. The generous 
reception of the members of the Commission by Chinese citizens 
in many parts of the Republic and the interest expressed in the work 
are also convincing. It is the opinion of the Commission that there 
will be no serious obstacle found in the attitude of the people at 
large toward the new medicine if properly presented and if matters 
are wisely handled. 



90 



VII 

RECOMMENDATIONS OF THE COMMISSION 

In the light of the facts as gathered by the Commission the fol- 
lowing recommendations are made to the Rockefeller Foundation: 

MEDICAL WORK IN CHINA 

That the Foundation should undertake medical work in China. 
In the opinion of the Commission the need is great beyond any of 
their anticipations and the opportunities for progress in all lines are 
equally great. 

CO-OPERATION WITH MISSIONARY INSTITUTIONS 

That the Foundation so far as possible should co-operate with 
existing missionary institutions which have already done such good 
work in China. 

HIGH STANDARD FOR MEDICAL INSTRUCTION 

That medical instruction in which the Foundation is concerned 
should be on the highest practicable standard. Such standard 
at the present time seems to include as a requirement for admission 
to a medical school the training of a middle school (roughly equiva- 
lent to an American High School) supplemented by two years of 
pre-medical work devoted to instruction primarily in English, Chi- 
nese, physics, chemistry, and biology. 

ENGLISH AS THE PRINCIPAL MEDIUM OF INSTRUCTION 

That the teaching in medical schools in which the Foundation 
is concerned for the present and for some time to come should 
be in English as the main language. A part of the instruction might 
be in Chinese and it might be possible in most classes to have expla- 
nations given in Chinese. 

PUBLIC HEALTH — TIME NOT RIPE FOR LARGE WORK BY FOUNDATION 

That on account of the lack of suitably trained men, and for 
other reasons, the time is not yet ripe for the Foundation to assist 
in the organization of a large work in relation to public health. 

91 



92 China Medical Commission 

However, the Commission believes that a useful foundation for 
such work might be laid by assisting one or more local hospitals, on 
condition that the work of the institution should be under the con- 
trol of a physician approved by the Foundation or its representative. 

If a suitable physician, acquainted with the Chinese language, 
were found for this position he would naturally become the adviser 
of the local authorities on public-health matters. He could prob- 
ably from the beginning do a great deal of vaccinating among the 
general public against small-pox, as much has already been done in 
various places. He would also be able to do effective therapeutic 
work in the cholera epidemics which recur in China every few 
years. In this way and through his hospital practice he should so 
win the confidence of the authorities and the people that they would 
be likely to give respectful consideration to his recommendations 
in regard to means of preventing these and other diseases. 

AN INDEPENDENT INSTITUTION FOR RESEARCH NOT 
RECOMMENDED 

That it is not advisable at this time to establish an independent 
institution for research in China, but that research be encouraged 
in connection with the medical schools aided. 

MEDICAL SCHOOL AT PEKING 

That the first medical educational work organized should be 
in the city of Peking and that it be in connection with the Union 
Medical College if suitable arrangements can be made. 

MEDICAL SCHOOL AT SHANGHAI 

That on account of the population, wealth, and convenience of 
location of the city of Shanghai, the second medical work of the 
Foundation be established in that city. 

In the opinion of the Commission it is unfortunate that there 
should be in Shanghai two competing medical schools both under 
American auspices and both teaching in the English language. 

It also seems to the Commission much wiser that well supported 
schools of medicine should not be undertaken both in Shanghai and 



Recommendations of the Commission 93 

in Nanking. One strong institution in the lower Yangtze Valley 
would be better and the better place for such institution is in the 
larger city. 

The Commission therefore recommends : 

1) That there be established at Shanghai a new institution, 
perhaps chartered under the laws of the State of New York, to be 
known as the Shanghai Medical College or by some other name 
acceptable to the various interests concerned. 

2) That provision be made for co-operation with existing medical 
schools in and near Shanghai on such basis as would be advantageous 
to the co-operating schools and would unite the medical educa- 
tional forces and the principal hospitals of the entire lower Yangtze 
Valley contributory to Shanghai. 

The Commission hopes that the above plan will make it possible 
to unite all the medical forces in the vicinity of Shanghai in medical 
education of a high grade in order to secure the advantages of union, 
while at the same time leaving to each co-operating institution its 
entire autonomy. A special advantage to the united institution will 
lie in making it possible to have proper arrangements with the various 
missionary secondary schools and further with the various missionary 
hospitals in the territory. On the other side the advantages to the 
co-operating institutions will lie in being connected with an institu- 
tion financially strong and therefore permanent in character and 
situated in a city which will afford the greatest amount of clinical 
material and probabty the most substantial support among the 
Chinese. 

MEDICAL EDUCATION AT CANTON 

That assistance should be given to the plans of the Canton 
Christian College for medical education. The particular form of 
such aid cannot be determined at this time on account of some 
pending questions with reference to the Canton Hospital. 

MEDICAL EDUCATION AT CHANGSHA 

That aid be given to the medical plans of the Yale Mission at 
Changsha. In the opinion of the Commission it is advisable to put 
such aid in a form which will be likely to stimulate the interest and 
support of the Hunanese. 



94 China Medical Commission 

MODEL TUBERCULOSIS HOSPITALS 

That two model tuberculosis hospitals be established in China 
and that expert advice be secured as to location and organization. 
Kuling in the Yangtze Valley and the Western Hills between Peking 
and Paotingfu are tentatively suggested as possible locations. Our 
attention was called in all parts of China to the overwhelming prev- 
alence of tuberculosis. It has become especially common among the 
student classes. Plans for a sanitarium situated near Peking are 
already being formulated. 

FELLOWSHIPS 

That six Fellowships yielding $1,000 gold a year and neces- 
sary traveling expenses be maintained in order to enable selected 
Chinese graduates in medicine to prosecute further study abroad. 

SCHOLARSHIPS 

That in connection with the medical schools aided provision 
be made for a limited number of scholarships in order to encourage 
selected young men who have no sufficient financial means to pursue 
the study of medicine. It is suggested that ten be offered for the 
year 1915-16 and ten additional yearly until the total number reaches 
fifty. The expense will be $750 in the first year and $3,750 in the 
fifth year and thereafter. 

THE DEVELOPMENT OF HOSPITALS 

That hospitals be developed first of all in the fields tributary 
to the medical schools which may be aided by the Foundation. Aid 
may be given to other hospitals as circumstances may warrant. 

The following suggestions are submitted : 

Increasing the Staff of Foreign Doctors. — That the Foundation 
offer to pay the salaries of additional foreign medical men selected 
by the missions and subsequently approved in each individual case 
by the Foundation. These doctors should be sent only to hospitals 
already established, so that they would be additional members of 
the hospital staff. This system would put the task of finding 
medical men on the missions, but would solve the question of the 
lack of medical men in so far as it depends on the lack of money for 
salaries. It would also prepare more hospitals to be proper institu- 
tions for the clinical training of medical school graduates. 



Recommendations of the Commission 95 

Provision for the Salaries of Chinese Doctors in Hospitals. — 
These men should be graduates of schools recognized by the Rocke- 
feller Foundation and their appointment should be subject to the 
approval of the representative of the Foundation in China. 

The provision of salaries for the Chinese would be of direct value 
in two ways: on the one hand, it would help to give the hospitals 
more efficient staffing; on the other hand, it would provide oppor- 
tunities for a considerable number of Chinese graduates to continue 
hospital work for a series of years. Some of these men might give 
their full time to the hospital, and some perhaps half time. It is 
of great importance that Chinese graduates be kept in touch with 
hospitals, so that their standard of work will not deteriorate. By 
this means they will be constantly under the supervision of trained 
foreign physicians. 

Provision of Salaries for Foreign Nurses. — That the Founda- 
tion support a considerable number of foreign nurses in hospital 
work. These nurses should be nominated by the missions, and sub- 
sequently approved by the Rockefeller Foundation. The attempt 
should be made to have them sent, first of all, to the better-equipped 
and better-staffed hospitals. The lack of nurses would thus be 
met, in so far as it depends on the lack of money on the part of 
the missions. 

Equipment. — It is impossible to undertake to provide suitable 
equipment for even a small proportion of the hospitals in China. 
However it would be most important to increase the equipment of 
certain hospitals, and more especially those which can be brought 
into line with the medical schools which may be aided by the 
Foundation and of those hospitals which have an adequate medi- 
cal and nursing staff. It is, of course, quite unnecessary to pro- 
vide much increased equipment for a hospital which has only 
one doctor. 

Business Managers. — In many hospitals the efficiency of the 
medical staff can be enormously increased by the provision of a 
salary for a business manager. This man may be either foreign 
or Chinese. 

The Establishment of Diagnostic Laboratories. — One of the greatest 
needs of practically every hospital in China is an opportunity 



96 China Medical Commission 

to get modern laboratory diagnostic measures carried out. There 
are not more than three or four hospitals in China, outside of Peking 
and Shanghai, in which pathological material can be studied. It 
would be quite simple to provide a system by which bacteriological, 
serological, and pathological work could be done in a central labora- 
tory. The hospitals could send specimens in special containers by 
mail, and the material could be worked up for the most part by 
trained technicians, as is done in the large Board of Health labora- 
tories in foreign countries. Reports, together with specimens, could 
then be returned as soon as possible to the hospitals. Such a 
system would have a twofold value: it would help the hospital, in 
that it would provide adequate diagnostic information; and it 
would stimulate the physician by helping him to know exactly 
what he was dealing with and keeping him in touch with scientific 
work. It would help the laboratory, by bringing in an enormous 
amount of material which would form the basis for important re- 
search studies. It would also serve as a check on the grade of work 
done by the various hospitals, and by the men working in them, and 
would tend to bring many country hospitals in close connection with 
the more important centers. Such diagnostic laboratories should be 
established in Peking and Shanghai in connection with the pathologi- 
cal departments of the medical schools. This would provide much 
material for teaching purposes and would also make the expense of 
an entirely separate plant unnecessary. 

Medical Libraries. — One need emphasized by many of the best 
medical men in China is some means of getting hold of medical 
literature. At least one, probably two, extensive libraries contain- 
ing especially files of medical journals should be established in con- 
nection with medical schools. These libraries should be provided 
with competent librarians and such assistance as will enable them 
to send books anywhere in China. 

THE TRAINING OF NURSES 

That encouragement be given to the training of nurses, especially 
in hospitals aided by the Foundation. 

(1) In special cases it may be desirable to give aid in the way of 
providing dormitories in connection with schools for nurses. 



Recommendations of the Commission 97 

(2) It is desirable that a reasonable number of scholarships (not 
over five at the beginning) be established in order to enable selected 
Chinese women to receive nurses' training in the United States. 
This will provide a group of highly trained women who may become 
teachers of nursing and superintendents of hospitals. 

(3) Provision should be made for the translation into Chinese of 
textbooks on nursing. The Nurses' Association of China already 
has in view an English-trained Chinese nurse who is competent to 
do the work. 

SPECIAL INSTRUCTION FOR HOSPITAL STAFF — RESIDENT FELLOWS 

That as soon as the medical schools aided by the Founda- 
tion become strong and well equipped, medical men in hospitals 
under pay from the Foundation spend three months in each year 
pursuing advanced work in such schools. In this way the members 
of the staff of various hospitals will keep informed on the progress of 
medical science and will constantly refresh their professional knowl- 
edge and skill. Further, such evidence will afford an opportunity 
for investigation along lines which may be suggested in hospital 
practice, and will at the same time bring to the medical school 
faculty the results of observations in the field. Members of a hos- 
pital staff during residence at the medical school may be known as 
"resident fellows." 

A RESIDENT COMMISSIONER IN CHINA 

That the Foundation be represented in China by a resident 
commissioner, who will administer the affairs of the Foundation in 
connection with the institutions aided. He will make regular reports 
and recommendations. The commissioner should have a suitable 
staff. Peking should be his headquarters. 

ADVISORY COMMITTEES 

That in order to carry out the foregoing recommendations, 
an advisory committee of medical men be formed in the United 
States, and, if circumstances warrant, a similar committee in Great 
Britain. 



98 China Medical Commission 

It should be the function of these committees to consider the 
qualifications of medical men whose appointment is subject to the 
approval of the Foundation; to consider technical questions as to 
the curriculum, equipment, or policy; and in general to aid the 
Foundation with reference to its work in China on all strictly profes- 
sional matters. 

EXPERT LECTURERS 

That from time to time, as may appear expedient, specialists 
in various branches of medical science be sent to China by the 
Foundation to lecture in medical schools aided by the Foundation 
and elsewhere. 

These specialist lecturers may at the same time be of use to the 
resident commissioner in the way of advice on matters technical 
in their character. 

The lecturer may or may not be a member of the Advisory Com- 
mittee. If not, he would naturally be considered later for appoint- 
ment to that Committee. 

Thus in time there will be a considerable number of high class 
medical men who will be conversant by personal observation with 
medical affairs in China. 

FELLOWSHIPS FOR MISSIONARIES 

That provision be made for ten fellowships annually for 
medical missionaries in China to enable them to proceed to the 
United States or Europe for advanced study, and that the annual 
stipend be $1,500, with $1,000 for expenses. 



APPENDIXES 

A. The Authority and Instructions of the Commission. 

B. Chinese Official Papers — Copies. 

1. Letter from the Minister of Education. 

2. Letter from the Governor of Hunan. 

3. Order of the Board of Education concerning Curriculum. 

4. Requirements for Middle Schools. 

5. Course of Study in Peking Medical Special College. 

6. Course of Study in Peiyang Military Medical College. 

7. Regulations of the Board of Interior as to Dissection. 

C. Estimated Population of China by Provinces and of Its Principal 

Cities. 

APPENDIX A 

THE AUTHORITY AND INSTRUCTIONS OF THE COMMISSION 

To Whom It May Concern: 

Be It Known that the Rockefeller Foundation, a charitable 
corporation established under the laws of the State of New York, in 
the United States of America, has appointed the following persons to 
serve as the 

China Medical Commission 

OF the Rockefeller Foundation: 

Harry Pratt Judson, LL.D., President of the University 
of Chicago, Trustee of the Rockefeller Foundation, 
Member of the General Education Board, etc.. 
Chairman; 

Roger Sherman Greene, A.M., Consul-General of the 
United States of America at Hankow; 

Francis Weld Peabody, M.D., of Harvard University 
and the Peter Bent Brigham Hospital, Boston, Mass. 



George B. McKibbin, Secretary to the Commission. 

99 



100 China Medical Commission 

The purpose of the Rockefeller Foundation, as stated in the 
Charter (Chapter 488 of the Laws of 1913), is that "of receiving and 
maintaining a fund or funds and applying the income and principal 
thereof to promote the well-being of mankind throughout the world. " 

The purpose of the above-named Commission is to inquire into 
the condition of medical education, hospitals, and public health in 
China. 

In order to accomplish the objects of their appointment the mem- 
bers of the Commission will depend, from time to time, upon the good 
offices of pubUc officials and of both public and private agencies and 
institutions concerned with medical education and the treatment 
or prevention of disease. To all such and to any other agencies, 
institutions, or individuals who may be in a position to further the in- 
quiries of the Commission, its members are respectfully commended 
by the President and Trustees of the Rockefeller Foundation. 

Given in the City of New York and State of New York, in the 
United States of America, this twenty-first day of March, in the 
year nineteen hundred and fourteen. 

(Signed) John D. Rockefeller, Jr., President. 
(Seal) 
(Signed) Jerome D. Greene, Secretary. 



Appendixes 101 

APPENDIX B 

1. LETTER FROM THE MINISTER OF EDUCATION 

(Translation) 

Ministry of Education, 
Pekin, June 19, 1914. 

To Dr. H. P. Judson, 

Representative, Rockefeller Foundation: 

Dear Sir: I appreciated very much your visit and listened to 
your conversation with great interest. I understand that your 
mission to China is connected with medical education especially 
with the provision of funds for encouragement of the same. The 
work is philanthropic and truly worthy of one who has humanitarian 
principles at heart. Therefore all your proposals meet with my 
hearty support. 

I am. 

Dear Sir, 

Your obedient servant, 

(Signed) Tang Hua-lung 

Minister of Education. 



102 China Medical Commission 

(Copy) ; 

2. letter from the governor of hunan \ 

Government House 'I 

Hunan 

Changsha, July 20, 1914. 
Office of the Governor. I 

My Dear Sir: Your very kind letter of June 20 has been re- 
ceived and I am very glad that you were able to call on my brother i 
while you were in Peking. 

Your visit and that of your colleagues to Changsha is sure to 
prove a great impetus to the cause of medical education. The I 

people of Hunan are rapidly awakening to the advantages of western j 

medicine, and if their usual enthusiasm can be aided by men and i 

equipment from without, to supplement what we can do locally, it 
should be possible to develop here at Changsha a big Medical School 
of high standard. The city is growing in every sense of the word and 
I am personally grateful for what interest you may take for the cause 
of medical education in this province. 
I am, 

Yours cordially, 

(Signed) S. M. Tan. 

Dr. Harry Pratt Judson, 

Care Messrs. Thomas Cook <Sc Son, 
Yokohama, Japan. 



Appendixes 



103 



3. ORDER OF THE BOARD OF EDUCATION CONCERNING THE 
CURRICULUM OF MEDICAL SPECIAL COLLEGES 

Curriculum and Regulations: 

I. Medical Schools shall have as their object the training of 
medical men. 
II. The regular course of medical schools shall last four years. 

III. Medical schools may establish preparatory departments whose 
course shall last one year. 

IV. Medical schools may establish research departments for then* 
graduates. Courses in these may last one year and upward. 

V. The curriculum of a medical school shall be as follows: 



1. German 

2. Chemistry 

3. Physics 
Anatomy dissection 
Dissection on organs 
Histology 
Embryology 
Physiology 
Medical chemistry 
Hygiene 
Bacteriology 

12. Pathology 

13. Pathological anatomy 
Pharmacology 
Diagnosis 
Medicine 
Surgery 

18. Orthopedics 

19. Eye diseases 

20. Ear, nose, and throat diseases 

21. Gynecology 
Obstetrics 
Pediatrics 
Dermatology 
Venereal diseases 
Nervous diseases 
Medical jurisprudence 



4. 

5. 

6. 

7. 

8. 

9. 
10. 
11. 



14. 
15. 
16. 
17. 



22. 
23. 
24. 
25. 
26. 
27. 



28. Practical work in chemistry and 

physics 

29. Practical work in anatomy 

30. " " " histology 

31. " " " physiology 

32. " " " medical chemis- 
try 

33. Practical work in pathological 

anatomy and histology 

34. Practical work in hygiene 

35. " " " bacteriology 

36. " " " pharmacology 

37. " " " medicine 

38. " " " surgery 

39. " " " bandaging 

40. " " " eye diseases 

41. " " " ear, nose, and 
throat diseases 

42. Practical work in gynecology 

43. " " " obstetrics with 
manikin work 

44. Practical work in pediatrics 

45. " " " dermatology 

46. " " " venereal diseases 

47. " " " nervous diseases 

48. " " " medical jurispru- 
dence 



VI. The arrangement of the schedule of all the courses in the school 
shall be determined by the Principal and shall be reported to 
the Minister of Education. 



104 



China Medical Commission 



VII. Medical schools shall provide suitable quarters for practical 
work, and all needed charts, books, apparatus, instruments, 
and specimens for the students. 

VIII. Medical schools may, according to special needs, institute a 
department of materia medica and pharmacy following the 
rules and regulations of schools of pharmacy and designate 
them accordingly. 
IX. All public and private medical schools, in addition to con- 
forming to the orders for schools in special branches and to 
the rules and regulations laid down for public and private 
schools in special branches, shall be carried on in accordance 
v/ith the present rules and regulations. 
X. These rules and regulations are in force from the date of their 
publication. 

Departmental Order No. 25. 
Date: November 22, 1912. 

4. CHINESE CENTRAL BOARD OF EDUCATION REQUIREMENTS FOR 
MIDDLE SCHOOLS ("hIGH SCHOOL" EQUIVALENT) 

Transcribed from "Orders of the Board of Education" January, 1913 



Subjects 



Ethics 

Chinese hterature 
Foreign language . 
History (Chinese) 

Geography 

Mathematics. . . . 
Natural science . . 

Physics 

Chemistry 

Economics 

Drawing 

Manual training . 

Music 

Physical culture . , 

Total hours . 



Hours 



1st Year 2(1 Year 3 d Year 4th Year 



33 



34 



35 



36 



Notes. — (a) As to foreign language. English is to be given the preference, 
but according to local conditions French, German, or Russian may be substi- 
tuted. 



Appendixes 105 

(6) Special emphasis is to be laid upon the History of China, with more 
general courses in universal history, especially in relation to its bearing upon 
China. 

(c) Mathematics include arithmetic, algebra, and geometry. 

(d) Natural science includes botany, zoology, mineralogy, human physiol- 
ogy, and hygiene, with as much laboratory work as possible. 

(e) Drawing includes Free-Hand and Mechanical Drawing. 

(/) No school shall give less than 32 hours per week, nor more than 36. 

(g) The number of instructional days per year shall not fall below 220. 
Time spent in examination or review shall not be included in this minimum. 

(h) The number of students in any one middle school shaU not exceed 400, 
except in specially authorized cases. 

(i) The number of students in each class shall not exceed 50, except in 
specially authorized cases. Music, ethics, and physical culture only may be 
taught in larger groups. 

(j) Provincial middle schools shall have their principals appointed by the 
Civil Governor of the Province. Teachers shall be appointed by the principal, 
but notification of such appointments must be sent to the Civil Governor. {Pro- 
vincial Middle Schools are those supported by provincial funds.) 

{k) District middle schools shaU have their principals appointed by the 
District Magistrate, with the sanction of the Civil Governor of the Province. 
Teachers shall be appointed by the principal, but notification of such appoint- 
ments must be sent to the District Magistrate, and transmitted by him to the 
Civil Governor of the Province. 

(l) Private middle schools shall have their principals appointed by the 
association of citizens estabhshing the school, but notification of such appoint- 
ment must be sent to the Civil Governor of the Province. 

(m) No middle school shall employ less than eight teachers. If the number 
of sections or classes exceeds fovu", the teaching staff shall be further increased so 
that not less than three teachers shall be employed for every two extra classes. 

(n) The location of every middle school shall be determined after a careful 
consideration of moral and sanitary surroundings. 



106 



China Medical Commission 



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108 China Medical Commission 

6. PEIYANG MILITARY MEDICAL COLLEGE 

(Established by the Department of War) 
Schedule of Courses 

FIRST YEAR 
Name Hours per Week 

1. Anatomy 12 

2. Histology 2 

3. Physiology (Second half-year) 6 

4. Inorganic Chemistry (First half-year) 7 

5. Organic Chemistry (Second half-year) 7 

6. Physics 3 

7. MiUtary Science 

8. Japanese 3 

9. Ethics 1 or more. 

10. Drill or Exercise 4 or more. 

11. Riding 2 or more. 

SECOND YEAR 

1. Laboratory Anatomy 2 

2. Embryology 1 

3. Pathology (First half-year) 5 

4. Pathological (Morbid) Anatomy (Second half-year) 6 

5. Physiology 5 

6. Materia Medica 4 

7. Immunity (First half-year) 3 

8. Bacteriology (Second half-year) 3 

9. Physical Diagnosis 4 

10. Surgery 4 

11. German 4 

12. Practical Histology 4 or more. 

13. Practical Anatomy 4 

14. Drill or Exercise 2 or more. 

15. Riding 1 or more. 

THIRD YEAR 

1. Practice of Medicine 4 

2. Surgery 4 

3. Diseases of the Eye 5 

4. Medical Chemistry, Laboratory work (First half-year) 4 or more. 

5. Diseases of the Ear, Nose, Throat 2 

6. Diseases of the Skin 2 

7. Bacteriology, laboratory work 4 or more. 

8. Practice in Hospitals 6 or more. 

9. CUnical Medicine and Surgery 4 

10. SyphiHs 1 

11. German 4 

12. Drill or Exercise 2 or more. 

13. Riding 2 or more. 



Appendixes 109 

FOURTH YEAR 

1. Practice of Medicine 4 

2. Surgery 4 

3. Hygiene 4 

4. Mental Diseases 2 

5. Therapeutics 2 

6. German 4 

7. Drill or Exercise 2 or more. 

8. Riding 1 or more. 

9. Hospital Practice 6 or more. 

10. Clinical Medicine 2 

11. Clinical Surgery 2 

12. Clinical Ophthalmology 2 



7. REGULATIONS OF THE BOARD OF INTERIOR 
Issued November 22, 1913. Order No. 51. Government Gazette 563. 

We have adopted five regulations regarding dissection which we 
now especially proclaim. 

REGULATIONS FOR DISSECTION 

1. A physician, in a case of death from disease, may dissect the 
body and inspect the diseased part to determine (examine) the 
origin of the disease, but he must first obtain consent of the rela- 
tives of the deceased and clearly inform the local magistrate before 
proceeding to dissection. 

2. The police and inspectors, in case of mysterious death, the 
cause and origin of which cannot be accurately ascertained without 
autops}^, may appoint a physician to dissect said corpse. 

3. The bodies of all those meeting death by punishment or dying 
in prison from disease, without relatives or friends to claim their 
bodies, may be given by the local magistrate to a physician for 
dissection, to be used for the purpose of experimentation in medical 
science, but after dissection the body must be sewed up and buried. 

4. If any are willing for the benefit of science to offer their bodies 
for dissection and leave word to that effect before death (they may 
do so), but the whole body must be sewed up and returned to his 
or her family after dissection. 

5. These regulations are in force from the day of their proc- 
lamation. 



110 



China Medical Commission 



APPENDIX C 



ESTIMATE OF THE POPULATION OF CHINA BY PROVINCES AND PRINCIPAL CITIES 
AND THE AREA OF THE PROVINCES 





National Review 
Annual 


Maritime 
Customs 
Returns 


Population of 
Principal Cities 




Area Sq. 
Miles 


Population 


National 
Review 


Customs 


Anhwei 


54,826 


23,672,300 


36,000,000 






Anking 


40,000 
137,000 




Wuhu 








89,000 


Chekiang 


36,680 


11,580,000 


17,812,000 


Hangchow 


350,000 
260,000 
500,000 


594,000 
455,000 


Ningpo 








Shaohing 








Chihli 


115,830 


20,930,000 


29,400,000 




Peking 


500,000 

80,000 

750,000 




Paotingf u 










Tientsin 








800,000 


Fukien 


46,332 


23,870,000 


20,000,000 


Foochow 


624,000 
114,000 
500,000 


624,000 
114,000 


Amoy 








Changchowf u 








Honan 


67,954 


25,317,820 






Kaifengfu 




200,000 




Hunan 


83,398 


22,169,000 


22,000,000 




Changsha 


500,000 

300,000 

300,000 

20,000 


250,000 


Changteh 








Siangtan 










Yochow 








20,000 


Hupeh 


71,428 


35,280,000 


34,000,000 


Wuchang 


500,000 
870,000 
400,000 


166,000 

590,000 

70,000 


Hankow 








Hanyang 








Kansu 


125,483 


10,386,000 




Lanchowf u 




500,000 




Kiangsi 


69,498 


26,532,000 


24,534,000 




Nanchangfu 


300,000 
38,000 




Kiukiang 








36,000 


Kiangsu 


38,610 


23,980,230 


26,920,000 


Nanking 


350,000 
168,000 
966,000 
500,000 


269,000 
184,000 
651,000 
500,000 


Chinkiang 








Shanghai 








Soochow 








Kwangsi 


77,220 


5,142,000 


8,000,000 


KweiUnf u 


80,000 
25,000 
65,000 




Nanning 








87,600 
40,000 


Wuchow 








Kwangtung 


100,000 


31,865,200 


32,000,000 


Canton 


1,000,000 
500,000 

55,000 
100,000 

35,000 


900,000 


Fatshan 








Kongmoon 








62,000 


Sheklung 








Swatow 








70,000 


Kweichow 


67,182 


7,650,000 




Kweiyangf u 




100,000 
50,000 




Anshunf u 





















Appendixes 
APPENDIX C— Continued 



111 





National Review 
Annual 


Maritime 
Customs 
Returns 


Population op 
Principal Cities 




Area Sq. 
Miles 


Population 


National 
Review 


Customs 


Shansi 


81,853 


12,200,000 








Taiyuanfu 




250,000 
200,000 




Hweihwating 










Shantung 


55,984 


38,247,900 


38,000,000 




Tsinanf u 


100,000 
85,000 
35,000 

150,000 




Chefoo 








54,500 
34,000 


Tsingtao 








Tsiningchow 








Shensi 


75,290 


8,450,000 






Hsianfu 




1,000,000 
80,000 




Hanchungfu 










Szechuan 


218,533 


68,724,800 


71,456,000 




Chengtufu 


500,000 
620,000 
150,000 
140,000 




Chungking 








631,700 


Kiatingfu 








Wanhsien 










Yunnan 


146,718 


12,721,500 


7,571,000 




Yunnanfu 


45,000 




Manchuria (three Eastern 
Provinces, Fengtien, 
Kirin, and HeSung- 
chiang) 


363,700 


8,500,000 


19,290,000 




Moukden 


180,000 

75,000 

100,000 




Newchang 










Kirin 










Harbin 








81,400 


DaLren 








60,000 
30,000 


24,500 


Tsitsihar 








Hsinkiang (Chinese Tur- 
kestan) 


550,579 


1,200,000 






Kashgar 




60,000 




Mongolia 


1,267,953 


2,580,000 






Urga 




37,000 




Thibet 


463,320 


6,430,000 






Lhasa 




40,000 




Customs estimate for 
Honan, Shansi, 
Shensi, Kansu, and 
Kweichow together . 






55,000,000 














Grand totals 


4,178,371 


437,428,750 


441,983,000* 







• Exclusive of Hsinkiang, Mongolia, and Thibet. 

There has been no authoritative national census of China. The 
National Review, a weekty pubhshed by Chinese in English, gives in 
its annual for the year 1910 a so-called official estimate of the pop- 
ulation of the several provinces and principal cities, from which the 



112 China Medical Commission 

figures in the second column are taken. The Maritime Customs 
Report on the Foreign Trade of China for the year 1913 contains 
quite different figures, which are given in the third column. In 
general where the two authorities differ considerably, the lower 
estimate is more likely to be correct. The customs estimate includes 
only Chinese, but this affects only such cities as Dairen and Harbin 
which have large Japanese and Russian colonies and to a slight degree 
Shanghai. 



Appendixes 



113 



APPENDIX D 



DISTRIBUTION OF MISSIONARY HOSPITALS AND MEDICAL WORKERS IN CHINA 

BY PROVINCES 





Cities 

Having 

Missionary 

Doctors 


Hospitals 


Doctors 




Provinces 


Men 


Women 




Anhui 


5 

8 
10 
26 

8 
12 
12 

1 

4 
12 

3 
22 

2 

7 
19 

1 
22 

1 


5 
10 

18 
34 

9 
13 
22 

1 

6 
21 

4 
27 

2 

6 
24 

1 
17 

2 


7 
22 
26 
29 
14 
18 
22 

1 

5 
42 

5 
43 

2 
11 
27 

3 
33 

1 


1 
2 
12 
15 
3 
4 
6 


5 


Chekiang 


8 


Chihli 


6 


Fukien 


28 


Honan 


13 


Hunan 


10 


Hupeh 


13 


Kansu 


1 


Kiangsi 


3 

18 

1 

16 


2 


Kiangsu 


20 


Kwangsi 


2 


Kwangtung 

Kweichow ... 


9 


Shansi .... 




4 


Shantung 


8 

2 

12 


11 


Shensi 


1 


Szechuan 


6 


Yunnan 




Hsinkiang 






Manchuria (Feng- 
tien, Kirin, and 
Heilungkiang) .... 

Mongolia 


17 


22 


18 


14 


1 


Thibet 


























192 


244 


329 


117 


140 



Total number of doctors, men and women, 446. 

Total number of medical missionaries, including foreign nurses, 586. 

Note. — The above table is not absolutely accurate, as changes are constantly 
occurring. Furthermore answers were not received from all stations to which 
inquiries for information were addressed. Probably the actual number of mis- 
sionary hospitals is slightly larger than that stated. A few medical missionaries 
are not connected with any hospital, but are simply receiving out-patients at 
their homes or at small dispensaries. A few others are no longer actively engaged 
in medical work. 

The membership of the China Medical Missionary Association at the 
beginning of 1914 was as follows: 

Active members 470 

Honorary and corresponding members 54 

524 

This total includes some missionaries in Korea, Formosa, Japan, and other 
places outside China, and also a number of private practitioners. 



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